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
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 758 425.250000 15734.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 376 343.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1203 3386.500000 125300.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1252 4155.500000 141034.7500 33.9393
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 71 87.250000 4362.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 22.500000 1687.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 14.000000 1050.0000 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 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 20.000000 1110.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 173 309.000000 23175.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 89 155.500000 11662.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 122 217.000000 12043.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 39.500000 2962.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 80 81.000000 4050.0000 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 6 6.000000 306.3000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 388 973.250000 63708.4000 65.4594
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 722.0000 722.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 200 249.000000 12450.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 14 28.750000 1437.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 13 7.750000 193.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 264 497.250000 24862.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 35 38.250000 1912.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 13 10.750000 268.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 97 157.250000 7862.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 4.000000 200.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 48 77.750000 3887.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 105 149.000000 7450.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 4 4.000000 200.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 258 328.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 231 1028.750000 51437.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 63 92.000000 4600.0000 50.0000
INTR-T1013-INTERPRETER 8 65.500000 3098.2400 47.3014
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 162 767.000000 7650.0000 9.9739
OCCT-97530-OT SESSION BY LICENSED OT 24 117.250000 8033.2800 68.5141
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 32 121.000000 8230.6400 68.0218
PHY-97110GT-PT SESSION BY LICENSED PT 4 5.000000 357.2000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 194.000000 13349.2100 68.8104
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 9.000000 642.9600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 657 58563.00000 26034.1000 0.4445
Subtotal (Total Children Is Unduplicated) 767 62520.00000 185052.9500 2.9599
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Total 67648.750000 389796.1000 5.7621
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Number of Children (Unduplicated) With at Least One Service 1422
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Center 03
Flag Claims Units Chgs Paid
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R 238 135.500000 5041.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3202 2278.250000 95633.5000 0.0000
P 2442 23295.250000 54236.3300 54236.3300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 239 2110.000000 5986.7800 5986.7800
T 0 0.000000 0.0000 0.0000
9265 39803.750000 227936.2400 115.7000
Other 46 26.000000 962.0000 0.0000
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Total 15432 67648.750000 389796.1000 60338.8100