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
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 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 120 244.000000 12200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 12.000000 900.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
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 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 18.500000 1026.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 149 245.000000 17624.8500 71.9382
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 104 181.500000 13529.5000 74.5427
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 34 55.000000 4125.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 243 436.000000 24138.0000 55.3624
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 82.500000 5992.5800 72.6373
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) 554 1299.000000 81038.8800 62.3856
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 24 35.500000 1775.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 7 5.250000 131.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 13.000000 650.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.000000 150.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 258 338.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 80 278.500000 13925.0000 50.0000
INTR-T1013-INTERPRETER 80 158.750000 7937.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 82.000000 5858.0800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 204.250000 13385.6400 65.5356
Subtotal (Total Children Is Unduplicated) 346 1120.750000 43912.4700 39.1813
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Total 14593.750000 551820.3500 37.8121
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Number of Children (Unduplicated) With at Least One Service 2206
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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 14947 13924.500000 519274.8800 519850.9200
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
68 77.250000 4503.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 15478 14593.750000 551820.3500 520230.1700