CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
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 1004 980.500000 36278.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1754 7835.500000 289913.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1807 8816.000000 326192.0000 37.0000
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 32 30.750000 1537.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 90 90.250000 4512.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 11.000000 825.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 21 17.500000 1312.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 36 51.000000 4190.3600 82.1639
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 41 56.000000 3108.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 98 74.500000 5587.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 131 104.000000 7800.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 268 313.000000 17285.5000 55.2252
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 153 150.500000 14998.2300 99.6560
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 306.3000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 33 33.000000 1602.6900 48.5664
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 24 24.000000 1225.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 19 19.000000 969.9500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 20 20.000000 1021.0000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 7 7.000000 357.3500 51.0500
Subtotal (Total Children Is Unduplicated) 508 1009.500000 66741.6800 66.1136
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 64.000000 3200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1181 10666.00000 533220.0000 49.9925
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 61 81.000000 4050.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1193 11133.00000 111330.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 50 199.000000 13357.7800 67.1245
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.500000 125.0400 35.7257
OCCT-97530HM-OT SESSION BY OT ASST 85 503.250000 28671.5000 56.9727
OCCT-97530HMGT-OT SESSION BY OT ASST 3 12.000000 686.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 50 283.500000 19741.8800 69.6363
PHY-97110GT-PT SESSION BY LICENSED PT 3 6.000000 379.5900 63.2650
PHY-97110HM-PT SESSION BY PT ASST 47 369.000000 21092.0400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 175.500000 12083.2400 68.8504
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 3 3.000000 111.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1335 23498.75000 748048.4700 31.8335
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Total 33324.250000 1140982.1500 34.2388
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Number of Children (Unduplicated) With at Least One Service 1959
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Center 04
Flag Claims Units Chgs Paid
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R 37 50.750000 1877.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1196 1672.000000 64624.7500 101.7500
P 6585 17249.500000 393719.9800 383775.7500
D 2 2.000000 130.5000 0.0000
S 2 4.000000 148.0000 0.0000
H 2903 10028.500000 501926.4200 2920.0000
T 0 0.000000 0.0000 0.0000
4292 4080.500000 165748.7600 81.4600
Other 99 237.000000 12805.9900 1666.0000
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Total 15116 33324.250000 1140982.1500 388544.9600