CMS/EIP Fiscal Report Center: 05
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 412 171.250000 6336.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 403 365.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1093 2690.000000 99530.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1125 3227.000000 105866.2500 32.8064
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 69 102.500000 7687.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 26.000000 1950.0000 75.0000
Subtotal (Total Children Is Unduplicated) 98 140.500000 10479.0000 74.5836
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 3.250000 162.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.250000 6.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 25.500000 1275.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8 21.000000 210.0000 10.0000
PHY-97110-PT SESSION BY LICENSED PT 4 25.500000 1821.7200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 6.000000 342.9600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 9.250000 660.8200 71.4400
TRAV-TRAVS-Travel by mile 6 293.000000 130.3500 0.4449
Subtotal (Total Children Is Unduplicated) 23 387.750000 4784.6000 12.3394
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Total 3755.250000 121129.8500 32.2561
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Number of Children (Unduplicated) With at Least One Service 1132
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Center 05
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 2473 1642.000000 64700.9200 39715.5000
P 93 407.000000 6689.1100 6689.1100
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
2867 1706.250000 49739.8200 214.3200
Other 0 0.000000 0.0000 0.0000
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Total 5433 3755.250000 121129.8500 46618.9300