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
Payclass Filters:GR
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 1041 3271.750000 121036.2500 36.9943
Subtotal (Total Children Is Unduplicated) 1808 4317.250000 131220.5000 30.3945
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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 2 4.000000 217.9000 54.4750
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 3.000000 225.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 25.500000 1912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 36 64.000000 3552.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 37.500000 2812.5000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 261 523.500000 28235.6000 53.9362
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EI Services,Class #03
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 81 136.750000 6687.5000 48.9031
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 131 639.750000 31987.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 20 26.750000 1337.5000 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 5 11.000000 726.1000 66.0091
PHY-97110-PT SESSION BY LICENSED PT 13 72.000000 5143.6800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 65.000000 4643.6000 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 57 42.000000 1554.0000 37.0000
TRAV-TRAVS-Travel by mile 1001 77246.00000 32178.0900 0.4166
Subtotal (Total Children Is Unduplicated) 1774 91314.50000 271697.5900 2.9754
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Total 96155.250000 431153.6900 4.4839
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Number of Children (Unduplicated) With at Least One Service 2452
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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 18766 86984.500000 246026.0900 246026.0900
D 394 1194.500000 6260.3100 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 682 2877.250000 10223.9800 10223.9800
8102 5093.500000 168279.0600 0.0000
Other 3 5.000000 345.7500 0.0000
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Total 27948 96155.250000 431153.6900 256250.0700