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
Payclass Filters:GR
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 923 2592.250000 95913.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1915 3908.000000 130998.5000 33.5206
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 27 52.000000 2600.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 41.000000 3075.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 16.000000 1200.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 25.000000 1875.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 28.000000 1554.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
Subtotal (Total Children Is Unduplicated) 62 165.000000 10529.0000 63.8121
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 2176.5000 2176.5000
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 435 3074.000000 150675.0000 49.0159
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 104 117.250000 5862.5000 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 18 61.000000 4357.8400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.250000 160.7400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 4 22.000000 1258.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 20 74.500000 5306.3800 71.2266
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.250000 89.3000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 7.500000 428.7000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 192.000000 13405.7200 69.8215
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 10.750000 767.9800 71.4400
Subtotal (Total Children Is Unduplicated) 1468 15057.50000 310202.8100 20.6012
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Total 19130.500000 451730.3100 23.6131
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Number of Children (Unduplicated) With at Least One Service 2274
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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 14918 14683.750000 304580.9300 304580.9300
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
7760 4446.000000 147121.6300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 22679 19130.500000 451730.3100 304580.9300