CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 3.000000 111.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1 3.000000 111.0000 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 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 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 31.500000 1748.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 67.000000 5025.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 30.000000 2250.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 118 244.000000 13098.0000 53.6803
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 24.000000 1800.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 4.000000 153.1500 38.2875
OCTH-97167-OT EVAL HIGH COMPLEXITY 13 13.000000 663.6500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 15 16.000000 750.0000 46.8750
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 714.7000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 184 492.500000 29708.0000 60.3208
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 127 137.750000 6887.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 94 161.000000 8050.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 7 4.750000 118.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 75 156.750000 7837.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 12.250000 612.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 30 37.250000 1862.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 251 1401.000000 69300.0000 49.4647
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 533 3716.000000 37160.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 94 378.750000 26701.0900 70.4979
OCCT-97530HM-OT SESSION BY OT ASST 38 196.250000 11225.5000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 59 417.500000 28308.1000 67.8038
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 114.3200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 155 919.000000 63308.6700 68.8887
SPL-92508-GROUP SPL SESSION PER CHILD 3 6.750000 93.6900 13.8800
TRAV-TRAVS-Travel by mile 395 28545.00000 12700.4200 0.4449
Subtotal (Total Children Is Unduplicated) 576 36095.00000 274355.5400 7.6009
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Total 36590.500000 304174.5400 8.3129
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Number of Children (Unduplicated) With at Least One Service 593
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Center 52
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 3 51.000000 168.2400 160.7400
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 4025 33691.500000 133361.1400 133315.4110
1407 2848.000000 170645.1600 70.0000
Other 0 0.000000 0.0000 0.0000
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Total 5435 36590.500000 304174.5400 133546.1510