CMS/EIP Fiscal Report Center: 57
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 496 582.250000 21543.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 257 191.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1573 6264.500000 231786.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1601 7037.750000 253329.7500 35.9958
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 132 165.000000 8250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 31.500000 2362.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 53 64.500000 4837.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 32 41.500000 2303.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 215 234.000000 17530.5000 74.9167
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 11.500000 862.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 61 69.500000 5212.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 333 410.000000 22755.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 29 29.000000 1480.4500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 10 11.000000 561.5500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 22 23.000000 1174.1500 51.0500
Subtotal (Total Children Is Unduplicated) 526 1098.500000 67929.9000 61.8388
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 4.000000 200.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 79 79.000000 3950.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 16.000000 800.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 316 317.000000 15850.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 21 914.000000 22850.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1316 11159.00000 557950.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1321 11795.00000 117950.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 32 146.750000 10483.8200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 37 166.000000 11859.0400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 15 103.000000 5887.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 55 326.000000 23253.7200 71.3304
TRAV-TRAVS-Travel by mile 37 10833.00000 4820.5600 0.4450
Subtotal (Total Children Is Unduplicated) 1364 35858.75000 775854.6200 21.6364
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Total 43995.000000 1097114.2700 24.9372
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Number of Children (Unduplicated) With at Least One Service 1785
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Center 57
Flag Claims Units Chgs Paid
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R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 362 430.000000 16690.7500 55.0000
P 3503 3954.750000 161511.8600 158167.8800
D 0 0.000000 0.0000 0.0000
S 107 58.000000 4021.1800 4021.1800
H 9 11.500000 862.5000 0.0000
T 5559 27463.000000 373920.5100 373830.5700
5855 11920.750000 536312.2400 392166.5710
Other 102 156.000000 3758.2300 3758.2300
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Total 15498 43995.000000 1097114.2700 931999.4310