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: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 306 170.000000 6280.7500 36.9456
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 267 177.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 766 2211.250000 81205.7500 36.7239
Subtotal (Total Children Is Unduplicated) 835 2558.750000 87486.5000 34.1911
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 4 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 20.500000 1447.5000 70.6098
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 10.000000 680.0000 68.0000
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 6 12.000000 666.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 105 226.000000 15929.6500 70.4852
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 69 159.000000 11016.6600 69.2872
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 81.000000 4495.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 8.000000 527.7200 65.9650
SCREEN-T1023-SCREENING 27 27.000000 1350.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 408.4000 51.0500
Subtotal (Total Children Is Unduplicated) 165 567.500000 37621.4300 66.2933
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 55 56.250000 2812.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 40 70.500000 3525.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 25.750000 1287.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 14.500000 725.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 38 53.000000 2650.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.250000 6.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 65 89.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 129 733.500000 36675.0000 50.0000
INTR-T1013-INTERPRETER 12 84.000000 4200.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 223 1239.000000 12390.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 40.250000 2875.4600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 2 7.000000 500.0800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 69 347.500000 24470.9800 70.4201
TRAV-TRAVS-Travel by mile 285 20859.00000 9281.0500 0.4449
Subtotal (Total Children Is Unduplicated) 340 23621.25000 101430.0700 4.2940
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Total 26747.500000 226538.0000 8.4695
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Number of Children (Unduplicated) With at Least One Service 861
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Center 52
Flag Claims Units Chgs Paid
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R 13 12.500000 547.0000 18.5000
U 0 0.000000 0.0000 0.0000
B 299 289.000000 14333.2300 0.0000
P 1777 1728.000000 80851.0500 78243.5100
D 0 0.000000 0.0000 0.0000
S 293 248.000000 9039.2500 0.0000
H 106 134.750000 9395.5000 74.9000
T 2066 22824.500000 61769.0400 50289.1000
2112 1510.500000 50593.6800 36.6700
Other 1 0.250000 9.2500 9.2500
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Total 6667 26747.500000 226538.0000 128671.9300