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
Payclass Filters:GR
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 464 1229.250000 45417.5000 36.9473
Subtotal (Total Children Is Unduplicated) 980 2015.500000 60902.0000 30.2168
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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 12 21.000000 1575.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 17.000000 943.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 73 132.000000 9900.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 32 53.000000 3975.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 16.500000 1237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 90.000000 4995.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 28.500000 2137.5000 75.0000
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 44 50.000000 2500.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 218 515.000000 32966.6500 64.0129
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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 25 57.000000 2850.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 10.500000 750.1200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 5 10.000000 714.4000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 19.750000 1324.6000 67.0684
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) 284 1460.500000 27421.2600 18.7753
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Total 3991.000000 121289.9100 30.3909
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Number of Children (Unduplicated) With at Least One Service 1114
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Center 03
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 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
5204 3991.000000 121289.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5204 3991.000000 121289.9100 0.0000