CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 Page: 1
List order: No List
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 1064 995.500000 36833.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1770 7979.000000 295223.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1824 8974.500000 332056.5000 37.0000
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 62 63.750000 3187.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 112 101.750000 5087.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 12.500000 937.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 28 24.000000 1800.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 48 58.000000 4350.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 42 41.000000 2275.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 109 84.000000 6300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 183 143.500000 10762.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 0.500000 37.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 324 382.500000 21228.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 185 186.000000 15211.1900 81.7806
OCTH-97166-OT EVAL MODERATE COMPLEXITY 13 13.000000 663.6500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 52 52.000000 2654.6000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 11 11.000000 561.5500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 20 20.000000 1021.0000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 19 19.000000 969.9500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 620 1219.500000 77429.9900 63.4932
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 33 83.000000 4150.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1236 11571.00000 578550.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1227 11920.00000 119190.0000 9.9992
OCCT-97530-OT SESSION BY LICENSED OT 54 199.000000 14216.5600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 80 495.500000 28342.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 55 322.000000 22512.0200 69.9131
PHY-97110HM-PT SESSION BY PT ASST 48 316.000000 18062.5600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 142.250000 9962.3400 70.0340
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 1371 25051.75000 795099.9600 31.7383
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Total 35245.750000 1204586.4500 34.1768
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Number of Children (Unduplicated) With at Least One Service 1983
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Center 04
Flag Claims Units Chgs Paid
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R 498 753.000000 27861.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1041 1541.500000 60655.2500 46.2500
P 6796 18785.000000 427496.2600 418704.0000
D 1 1.500000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 2757 10492.500000 533615.2100 290.0000
T 0 0.000000 0.0000 0.0000
4010 3571.750000 148791.7500 0.0000
Other 45 100.500000 6111.4800 480.0000
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Total 15148 35245.750000 1204586.4500 419520.2500