CMS/EIP Fiscal Report Center: 06
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 1504 948.250000 35085.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 468 367.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2138 5803.000000 214693.0000 36.9969
Subtotal (Total Children Is Unduplicated) 2288 7118.750000 249778.2500 35.0874
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 35 69.500000 3475.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 11.500000 862.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.500000 337.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 370 575.500000 43157.8100 74.9919
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 103 158.000000 11850.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 131 198.000000 14850.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 338 537.500000 29831.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 15.000000 1125.0000 75.0000
Subtotal (Total Children Is Unduplicated) 525 1588.500000 106699.5600 67.1700
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 2176.5000 2176.5000
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 97 94.750000 4612.5000 48.6807
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 21 20.000000 500.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 6 7.250000 362.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 18 15.250000 381.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 1.750000 87.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 10 8.250000 206.2500 25.0000
CONPF-CONPF-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 5 6.000000 300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 7.250000 181.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1157 8283.000000 411125.0000 49.6348
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 228 273.000000 13650.0000 50.0000
INTR-T1013-INTERPRETER 34 101.000000 6960.0000 68.9109
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1428 11231.00000 112060.0000 9.9777
OCCT-97530-OT SESSION BY LICENSED OT 101 344.500000 23782.2300 69.0340
OCCT-97530GT-OT SESSION BY LICENSED OT 11 9.750000 696.5400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 29 111.000000 6306.2400 56.8130
OCCT-97530HMGT-OT SESSION BY OT ASST 5 4.000000 200.2000 50.0500
PHY-97110-PT SESSION BY LICENSED PT 106 443.000000 30688.8100 69.2750
PHY-97110GT-PT SESSION BY LICENSED PT 9 6.250000 446.5000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 11 24.000000 1371.8400 57.1600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 210 890.500000 62254.0800 69.9091
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 54 49.000000 3490.5600 71.2359
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.500000 107.1600 71.4400
Subtotal (Total Children Is Unduplicated) 1507 21938.50000 682731.4100 31.1202
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Total 30645.750000 1039209.2200 33.9104
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Number of Children (Unduplicated) With at Least One Service 2419
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Center 06
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 16328 15495.500000 359929.4400 359929.4400
D 1 0.750000 27.7500 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
20261 15149.500000 679252.0300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 36590 30645.750000 1039209.2200 359929.4400