CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 678 418.500000 15484.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 395 367.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1166 3054.500000 112951.7500 36.9788
Subtotal (Total Children Is Unduplicated) 1206 3840.750000 128436.2500 33.4404
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 65 90.000000 4500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 26.500000 1987.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 9.000000 675.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 21.000000 1165.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 140 253.500000 19012.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 67 115.500000 8662.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 33.000000 2475.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 99 170.500000 9462.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 57.000000 4275.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 75 87.000000 4350.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 331 876.000000 57444.9500 65.5764
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 53 61.250000 3062.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 6.250000 156.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 152 241.000000 12050.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 7 5.250000 131.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 22.750000 1137.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 16.750000 837.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 75 82.000000 4100.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 254 294.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 30 81.750000 4087.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 28.500000 2021.8000 70.9404
OCCT-97530HM-OT SESSION BY OT ASST 1 0.750000 42.9000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 5 12.000000 857.2800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 30.250000 2017.1600 66.6830
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 53 632.000000 280.7600 0.4442
Subtotal (Total Children Is Unduplicated) 285 1516.500000 30808.7800 20.3157
-----------------------------------------------------------------------------------------------------------------------
Total 6233.250000 216689.9800 34.7636
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1287
-----------------------------------------------------------------------------------------------------------------------
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 41 31.500000 1202.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2945 2153.250000 90460.8400 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5249 4048.500000 125026.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8235 6233.250000 216689.9800 0.0000