CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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 598 261.750000 9684.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 783 734.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2654 8948.500000 331076.0000 36.9979
Subtotal (Total Children Is Unduplicated) 2668 9944.500000 340760.7500 34.2663
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 22 32.500000 1625.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 15.500000 1162.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 0.500000 37.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 28 64.000000 4800.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 40.500000 2247.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 48.000000 3600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 32.500000 2437.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 11.500000 862.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 106 157.500000 8741.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 197 314.500000 23587.5000 75.0000
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 357.3500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 97.8800 48.9400
Subtotal (Total Children Is Unduplicated) 351 729.000000 49709.8800 68.1891
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 61 83.500000 4175.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1 0.500000 25.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 12 12.500000 312.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 20 28.500000 1425.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 2 2.000000 100.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 16 27.250000 681.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 29.500000 1475.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 5 4.000000 200.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 8 7.500000 187.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 30 43.500000 2175.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 5 4.500000 225.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.750000 43.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 33 46.750000 2337.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 9 9.000000 450.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 20 19.000000 475.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 127 581.750000 29087.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 31 36.250000 1812.5000 50.0000
INTR-T1013-INTERPRETER 197 244.500000 12225.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 36 198.750000 14198.7000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 15 15.250000 1078.7800 70.7397
PHY-97110-PT SESSION BY LICENSED PT 54 292.250000 20878.3400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 17 22.000000 1571.6800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 67 326.250000 23307.3000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 20 22.750000 1625.2600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 39 29.250000 1082.2500 37.0000
Subtotal (Total Children Is Unduplicated) 492 2090.750000 121225.8500 57.9820
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Total 12764.250000 511696.4800 40.0883
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Number of Children (Unduplicated) With at Least One Service 2676
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Center 01
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 2 1.750000 64.7500 64.7500
D 8 7.750000 521.1400 0.0000
S 5 4.000000 208.4400 0.0000
H 11031 7631.250000 332591.9300 297861.9900
T 0 0.000000 0.0000 0.0000
8047 5119.500000 178310.2200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 19093 12764.250000 511696.4800 297926.7400