CMS/EIP Fiscal Report Center: 07
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 1706 1851.750000 68496.2500 36.9900
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 729 700.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1755 4326.750000 159701.2500 36.9102
Subtotal (Total Children Is Unduplicated) 2026 6879.000000 228197.5000 33.1731
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 132 216.500000 10825.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 109 215.500000 16062.5000 74.5360
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 125 247.500000 13708.5000 55.3879
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 116 234.000000 17550.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 4.000000 172.2000 43.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 20 129.000000 6550.0000 50.7752
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 21 21.000000 1072.0500 51.0500
Subtotal (Total Children Is Unduplicated) 400 1105.500000 68334.5500 61.8133
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 124 141.500000 7075.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 155 338.750000 16937.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 2 2.000000 100.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 15 14.500000 362.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 43 68.000000 3400.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 25 50.500000 2525.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 97 156.750000 7837.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 3.500000 87.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 127 244.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 375 2489.750000 124487.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 33 73.750000 3687.5000 50.0000
INTR-T1013-INTERPRETER 3 3.660000 183.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1349 11065.00000 110546.2800 9.9906
OCCT-97530-OT SESSION BY LICENSED OT 27 135.000000 9084.3000 67.2911
OCCT-97530GT-OT SESSION BY LICENSED OT 3 6.000000 353.6400 58.9400
PHY-97110-PT SESSION BY LICENSED PT 15 73.500000 5165.8400 70.2835
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 133 918.000000 62478.8900 68.0598
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 10 14.750000 1053.7400 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 16.000000 657.8400 41.1150
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 13 9.750000 360.7500 37.0000
TRAV-TRAVS-Travel by mile 13 1126.000000 499.2600 0.4434
Subtotal (Total Children Is Unduplicated) 1393 16953.91000 356946.0400 21.0539
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Total 24938.410000 653478.0900 26.2037
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Number of Children (Unduplicated) With at Least One Service 2191
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Center 07
Flag Claims Units Chgs Paid
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R 26 127.000000 6129.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 957 703.500000 27455.0000 0.0000
P 9139 19607.497400 480735.7450 481380.1700
D 61 59.000000 3337.0500 0.0000
S 3 2.250000 96.2500 0.0000
H 25 49.000000 3651.0500 0.0000
T 0 0.000000 0.0000 0.0000
7834 4389.912600 132064.7450 0.0000
Other 1 0.250000 9.2500 0.0000
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Total 18046 24938.410000 653478.0900 481380.1700