CMS/EIP Fiscal Report Center: 05
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 461 194.250000 7187.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 398 371.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 449 1321.000000 48877.0000 37.0000
Subtotal (Total Children Is Unduplicated) 799 1886.250000 56064.2500 29.7226
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 22.500000 1687.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 7.000000 525.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 44 65.500000 3635.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 75.500000 5662.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 29.000000 2175.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 91.000000 5050.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 10.000000 750.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 27.9900 27.9900
OCTH-97167-OT EVAL HIGH COMPLEXITY 9 9.000000 433.0900 48.1211
PSTH-97163-PT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 13.000000 555.5100 42.7315
Subtotal (Total Children Is Unduplicated) 160 339.500000 21489.5400 63.2976
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 121 111.500000 5575.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 4 4.000000 200.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 107 69.750000 3487.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 1.250000 62.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 1.750000 43.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 33 21.000000 1050.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 26 14.500000 725.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 1.750000 43.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 71 49.000000 2450.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.000000 25.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 49.000000 1225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 299 1701.250000 85062.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 31 35.750000 1787.5000 50.0000
INTR-T1013-INTERPRETER 13 71.000000 3550.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 733 5223.000000 52230.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 27 107.750000 7337.5200 68.0976
OCCT-97530GT-OT SESSION BY LICENSED OT 6 9.000000 581.3000 64.5889
PHY-97110-PT SESSION BY LICENSED PT 42 156.500000 9593.6600 61.3013
PHY-97110GT-PT SESSION BY LICENSED PT 9 11.000000 745.8400 67.8036
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 101 386.000000 23969.4800 62.0971
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 14.250000 949.5800 66.6372
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 16 8.250000 305.2500 37.0000
TRAV-TRAVS-Travel by mile 757 90253.00000 40102.0400 0.4443
Subtotal (Total Children Is Unduplicated) 789 98304.25000 241202.1700 2.4536
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Total 100530.000000 318755.9600 3.1708
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Number of Children (Unduplicated) With at Least One Service 1062
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Center 05
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 8425 98445.500000 259781.9500 259781.9500
D 39 22.250000 861.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3291 2062.250000 58112.7600 2834.7600
Other 0 0.000000 0.0000 0.0000
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Total 11755 100530.000000 318755.9600 262616.7100