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
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 1706 1851.250000 68477.7500 36.9900
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 729 700.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 524 1348.500000 49681.7500 36.8422
Subtotal (Total Children Is Unduplicated) 1878 3900.250000 118159.5000 30.2954
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 132 216.500000 10825.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 39.833000 2887.4750 72.4895
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 45 89.000000 4939.5000 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 18 31.079600 2330.9700 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 121.1500 40.3833
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 203 396.412600 22033.4450 55.5821
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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 126 243.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 344 2325.750000 116287.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 32 72.000000 3600.0000 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 15 52.500000 3190.5000 60.7714
OCCT-97530GT-OT SESSION BY LICENSED OT 2 4.000000 210.7600 52.6900
PHY-97110-PT SESSION BY LICENSED PT 6 27.500000 1879.6000 68.3491
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 48 255.750000 15217.7500 59.5024
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 285.7600 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 14.000000 543.4400 38.8171
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) 1390 15981.41000 291192.1000 18.2207
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Total 20278.072600 431385.0450 21.2735
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Number of Children (Unduplicated) With at Least One Service 2141
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Center 07
Flag Claims Units Chgs Paid
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R 5 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 5419 15906.160000 300025.0500 300025.0500
D 45 28.000000 1036.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 7 14.000000 1050.0000 0.0000
T 0 0.000000 0.0000 0.0000
7758 4326.662600 129153.7450 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13234 20278.072600 431385.0450 300025.0500