CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 80 56.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 87 151.000000 5587.0000 37.0000
Subtotal (Total Children Is Unduplicated) 87 207.500000 5587.0000 26.9253
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 9.500000 527.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 36 59.000000 4425.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 84.000000 6300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 80 140.000000 7714.5000 55.1036
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
Subtotal (Total Children Is Unduplicated) 88 305.000000 19875.0000 65.1639
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 18.000000 900.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 2.500000 62.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 200 917.000000 45850.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 41 57.000000 2850.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 32 185.000000 13216.4000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 7 10.000000 714.4000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 52 314.000000 22432.1600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 3 11.000000 785.8400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 164 1005.500000 71832.9200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 31 76.000000 5429.4400 71.4400
TRAV-TRAVS-Travel by mile 781 41844.00000 18183.7200 0.4346
Subtotal (Total Children Is Unduplicated) 816 44443.00000 182407.3800 4.1043
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Total 44955.500000 207869.3800 4.6239
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Number of Children (Unduplicated) With at Least One Service 887
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Center 09
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 2280 43870.000000 177599.0600 177599.0600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 343 512.500000 25462.0000 0.0000
T 0 0.000000 0.0000 0.0000
41 573.000000 4808.3200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2664 44955.500000 207869.3800 177599.0600