CMS/EIP Fiscal Report Center: 09
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 1802 4324.250000 159997.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 717 636.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1946 7213.250000 266871.7500 36.9974
Subtotal (Total Children Is Unduplicated) 2156 12174.00000 426869.0000 35.0640
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 123 250.000000 12500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 16.000000 1200.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.500000 487.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 20.500000 1137.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 191 319.000000 23174.8500 72.6484
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 133 238.000000 17767.0000 74.6513
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 121 207.500000 15523.5000 74.8120
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 278 495.000000 27412.5000 55.3788
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 137 225.500000 16603.7500 73.6308
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 3.000000 150.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 5 52.000000 2600.0000 50.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 510.5000 51.0500
Subtotal (Total Children Is Unduplicated) 583 1863.000000 120471.5500 64.6654
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 351.7400 351.7400
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 163 282.250000 14112.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 51 46.750000 1168.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 19 24.500000 1225.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 15.000000 750.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 23 32.000000 1600.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 31.000000 1550.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.500000 37.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 258 338.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1298 8872.500000 443430.0100 49.9780
INTR-T1013-INTERPRETER 80 158.750000 7937.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 79 549.000000 5490.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 149 992.500000 70106.8400 70.6366
OCCT-97530HM-OT SESSION BY OT ASST 2 9.000000 344.5200 38.2800
PHY-97110-PT SESSION BY LICENSED PT 210 1558.000000 109940.8300 70.5654
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 510 4325.000000 305585.6000 70.6556
TRAV-TRAVS-Travel by mile 1643 154573.0000 67465.4700 0.4365
Subtotal (Total Children Is Unduplicated) 1862 171811.2500 1031121.2600 6.0015
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Total 185848.250000 1578461.8100 8.4933
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Number of Children (Unduplicated) With at Least One Service 2401
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Center 09
Flag Claims Units Chgs Paid
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R 2 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 171 174.000000 6973.5100 120.2500
P 21989 171162.000000 1042823.1900 1043399.2300
D 14 12.500000 772.4600 0.0000
S 0 0.000000 0.0000 0.0000
H 274 402.500000 20147.7500 0.0000
T 2 2.500000 129.5000 259.0000
2922 13768.750000 483886.4000 0.0000
Other 190 325.500000 23710.5000 0.0000
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Total 25564 185848.250000 1578461.8100 1043778.4800