CMS/EIP Fiscal Report Center: 02
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: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 788 680.500000 25178.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 214 254.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 240 284.000000 10480.2500 36.9023
Subtotal (Total Children Is Unduplicated) 843 1219.000000 35658.7500 29.2525
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 32 38.750000 1937.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 17.500000 1312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 13.000000 975.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 47.000000 2608.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 68 143.750000 8721.1500 60.6689
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 6.000000 1482.0800 247.0133
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 40 51.500000 2575.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 3 3.250000 162.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 7.250000 181.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 124 101.000000 5037.5000 49.8762
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 14 13.250000 625.0000 47.1698
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 30 23.500000 1175.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 12 6.500000 325.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 101 76.000000 3800.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 12 7.000000 350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 144 725.500000 36275.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 37 48.250000 2412.5000 50.0000
INTR-T1013-INTERPRETER 22 66.250000 3312.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 469 2534.000000 25340.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 62.250000 4447.1400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 15 64.750000 4625.7400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 47.250000 3375.5400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.750000 125.0200 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 16 10.000000 370.0000 37.0000
TRAV-TRAVS-Travel by mile 300 25807.00000 11481.6800 0.4449
Subtotal (Total Children Is Unduplicated) 637 29665.25000 107624.8900 3.6280
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Total 31028.000000 152004.7900 4.8990
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Number of Children (Unduplicated) With at Least One Service 1074
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Center 02
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 3 3.000000 100.0000 100.0000
H 0 0.000000 0.0000 0.0000
T 4245 17214.500000 89530.3700 89538.3700
80 250.250000 2022.0900 0.0000
Other 3647 13560.250000 60352.3300 0.0000
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Total 7975 31028.000000 152004.7900 89638.3700