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
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 496 582.250000 21543.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 257 191.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 613 2437.000000 90169.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1015 3210.250000 111712.2500 34.7986
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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 8 9.500000 712.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 11.500000 862.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 13.000000 721.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 13.500000 1012.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 7.500000 562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 34.500000 1914.7500 55.5000
OCTH-97167-OT EVAL HIGH COMPLEXITY 8 8.000000 408.4000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 561.5500 51.0500
Subtotal (Total Children Is Unduplicated) 180 276.500000 15159.3500 54.8259
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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 14 15.000000 750.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 306 307.000000 15350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 141 1108.000000 55400.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1318 11696.00000 116960.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 47.000000 3357.6800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 12 58.000000 4143.5200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 12.000000 685.9200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 128.000000 9144.3200 71.4400
TRAV-TRAVS-Travel by mile 37 10833.00000 4820.5600 0.4450
Subtotal (Total Children Is Unduplicated) 1332 24287.00000 214762.0000 8.8427
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Total 27773.750000 341633.6000 12.3006
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Number of Children (Unduplicated) With at Least One Service 1611
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Center 57
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 72 37.500000 2617.8300 2617.8300
H 0 0.000000 0.0000 0.0000
T 4648 24251.500000 213067.2700 212977.3300
3374 3477.750000 125878.5000 130.0000
Other 1 7.000000 70.0000 70.0000
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Total 8095 27773.750000 341633.6000 215795.1600