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
Agency Filter:EIP DEI DEIP
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 1881 5004.500000 185166.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 512 548.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 843 3291.500000 121739.2500 36.9859
Subtotal (Total Children Is Unduplicated) 2002 8844.250000 306905.7500 34.7012
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 110 221.000000 11050.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 49.500000 3712.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 23.000000 1725.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.500000 487.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 43.500000 2414.2500 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 14 25.000000 1875.0000 75.0000
Subtotal (Total Children Is Unduplicated) 172 379.000000 21983.5000 58.0040
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 16.000000 800.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1 2.000000 100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 8 8.250000 206.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 3.000000 150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 4.000000 200.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 191 247.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 23 105.000000 5250.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 3.000000 150.0000 50.0000
INTR-T1013-INTERPRETER 103 212.750000 10637.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 14.000000 1000.1600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 35.000000 2500.4000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 5.000000 357.2000 71.4400
Subtotal (Total Children Is Unduplicated) 299 657.250000 21494.3900 32.7035
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Total 9880.500000 350383.6400 35.4621
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Number of Children (Unduplicated) With at Least One Service 2057
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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 11487 9878.000000 350221.1400 350202.6400
D 0 0.000000 0.0000 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
0 0.000000 0.0000 0.0000
Other 2 2.500000 162.5000 0.0000
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Total 11489 9880.500000 350383.6400 350202.6400