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
Payclass Filters:GR
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 651 594.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 820 3049.250000 112822.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1991 7968.000000 272819.5000 34.2394
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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 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 36.500000 2737.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 12.500000 937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 37.000000 2053.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 14.000000 1050.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 173 363.500000 20295.6000 55.8338
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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 34 153.250000 7662.5000 50.0000
INTR-T1013-INTERPRETER 80 158.750000 7937.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 12.000000 857.2800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 19.000000 1357.3600 71.4400
Subtotal (Total Children Is Unduplicated) 344 740.250000 20620.8900 27.8567
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Total 9071.750000 313735.9900 34.5838
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Number of Children (Unduplicated) With at Least One Service 2055
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Center 09
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 10541 9057.000000 313133.4900 313133.4900
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
18 14.750000 602.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10559 9071.750000 313735.9900 313133.4900