CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 Page: 1
List order: No List
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1495 885.000000 32745.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 488 372.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2077 4888.000000 180834.2500 36.9956
Subtotal (Total Children Is Unduplicated) 2217 6145.250000 213579.2500 34.7552
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 48 90.250000 4512.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 156 235.500000 17662.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 68 101.500000 7612.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 153 228.500000 17137.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 347 523.000000 29026.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 222 350.500000 26287.5000 75.0000
Subtotal (Total Children Is Unduplicated) 535 1547.250000 103452.5000 66.8622
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 2885.7800 1442.8900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 103 100.750000 4887.5000 48.5112
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 9.000000 225.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 6 8.500000 350.0000 41.1765
CONIP-CONIP-CONSULT, ITDS PHONE 17 19.000000 475.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 3.000000 150.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 10 12.500000 312.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 4.000000 200.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 5.000000 250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 7.000000 150.0000 21.4286
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1111 8837.000000 441537.5000 49.9646
INTR-T1013-INTERPRETER 12 34.000000 2372.0000 69.7647
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1383 11816.00000 117680.0000 9.9594
OCCT-97530-OT SESSION BY LICENSED OT 99 326.000000 22898.4300 70.2406
OCCT-97530HM-OT SESSION BY OT ASST 34 141.000000 8086.2800 57.3495
PHY-97110-PT SESSION BY LICENSED PT 99 387.500000 26668.1200 68.8210
PHY-97110HM-PT SESSION BY PT ASST 10 26.250000 1514.7300 57.7040
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 203 913.000000 63085.7500 69.0972
Subtotal (Total Children Is Unduplicated) 1422 22651.50000 693728.5900 30.6262
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Total 30344.000000 1010760.3400 33.3101
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Number of Children (Unduplicated) With at Least One Service 2371
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Center 06
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 10554 10174.500000 224225.0900 224225.0900
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
24973 20169.500000 786535.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 35527 30344.000000 1010760.3400 224225.0900