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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 625 275.250000 10184.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 823 770.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2770 9442.500000 349354.0000 36.9980
Subtotal (Total Children Is Unduplicated) 2784 10488.00000 359538.2500 34.2809
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 9 9.000000 436.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 198 374.500000 18725.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 33.000000 2392.9000 72.5121
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 30 70.000000 5250.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 50.000000 2775.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 146 240.000000 17866.9000 74.4454
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 36.000000 2700.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 19.000000 1425.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 339 533.000000 29581.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 279 461.000000 34575.0000 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 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 561.5500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 97.8800 48.9400
Subtotal (Total Children Is Unduplicated) 692 1846.000000 116790.9800 63.2671
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 195.0000 195.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 287 381.750000 19047.5000 49.8952
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1 0.500000 25.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 45 49.250000 1231.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 79 145.500000 7275.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 2 2.000000 100.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 35 42.000000 1050.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 39 60.500000 3025.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 5 4.000000 200.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 9 8.500000 212.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 49 68.500000 3425.0000 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 82 138.750000 6787.5000 48.9189
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 9 9.000000 450.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 24 23.000000 575.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 569 3347.000000 167270.0000 49.9761
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 115 138.750000 6937.5000 50.0000
INTR-T1013-INTERPRETER 286 701.500000 35075.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1529 11571.00000 115394.3000 9.9727
OCCT-97530-OT SESSION BY LICENSED OT 64 403.750000 28754.2900 71.2181
OCCT-97530GT-OT SESSION BY LICENSED OT 22 24.000000 1703.8800 70.9950
PHY-97110-PT SESSION BY LICENSED PT 86 485.750000 34598.5900 71.2272
PHY-97110GT-PT SESSION BY LICENSED PT 21 26.000000 1856.3100 71.3965
PHY-97110HM-PT SESSION BY PT ASST 2 2.000000 114.3200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 155 814.750000 58203.9800 71.4378
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 30 34.750000 2482.5400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.000000 27.7600 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 57 42.000000 1554.0000 37.0000
TRAV-TRAVS-Travel by mile 1001 77263.00000 32185.4300 0.4166
Subtotal (Total Children Is Unduplicated) 1872 95796.75000 530025.4000 5.5328
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Total 108130.750000 1006354.6300 9.3068
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Number of Children (Unduplicated) With at Least One Service 2872
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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 21481 89739.500000 397960.7400 397960.7400
D 654 1458.750000 21363.4100 0.0000
S 6 5.000000 279.8800 0.0000
H 11496 8060.500000 351709.1200 315265.2400
T 863 3063.500000 21717.1600 21379.5200
8386 5401.000000 187319.5700 0.0000
Other 255 402.500000 26004.7500 0.0000
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Total 43141 108130.750000 1006354.6300 734605.5000