CMS/EIP Fiscal Report Center: 03
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 718 407.500000 15077.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 350 317.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1135 3115.250000 115264.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1184 3840.000000 130341.7500 33.9432
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 71 87.250000 4362.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 20.500000 1537.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 12.500000 937.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 16.000000 888.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 134 247.500000 18562.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 73 130.500000 9787.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 94 171.500000 9518.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 32.000000 2400.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 79 80.000000 4000.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 326 813.250000 52916.7500 65.0682
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 60 58.750000 2937.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 13 26.750000 1337.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 5.750000 143.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 180 293.750000 14687.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 33 35.500000 1775.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 13 10.750000 268.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 258 328.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 35 124.750000 6237.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 13.000000 650.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 23.000000 1628.8800 70.8209
PHY-97110-PT SESSION BY LICENSED PT 5 13.000000 928.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 89.250000 6260.9000 70.1501
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 142.8800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 28 2103.000000 935.5900 0.4449
Subtotal (Total Children Is Unduplicated) 290 3129.500000 37958.3500 12.1292
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Total 7782.750000 221216.8500 28.4240
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Number of Children (Unduplicated) With at Least One Service 1279
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Center 03
Flag Claims Units Chgs Paid
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R 232 130.000000 4837.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3006 2062.000000 85823.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 50.0000 50.0000
T 0 0.000000 0.0000 0.0000
5412 5563.750000 129543.3500 0.0000
Other 46 26.000000 962.0000 0.0000
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Total 8697 7782.750000 221216.8500 50.0000