CMS/EIP Fiscal Report Center: 51
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 584 877.000000 32430.5000 36.9789
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 170 186.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 615 1741.000000 64185.7500 36.8672
Subtotal (Total Children Is Unduplicated) 730 2804.750000 96616.2500 34.4474
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 47 47.000000 2350.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 91 95.000000 6925.9500 72.9047
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 9.000000 675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 15.000000 1125.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 5.000000 375.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 94 96.500000 5333.5000 55.2694
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 26.500000 1950.0000 73.5849
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 306.3000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 28 29.000000 1448.7800 49.9579
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 18 19.000000 969.9500 51.0500
Subtotal (Total Children Is Unduplicated) 234 376.000000 23205.3300 61.7163
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 313.8900 156.9450
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 7.000000 350.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 189 1108.500000 55425.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 6 10.500000 525.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 566 3527.000000 35153.0000 9.9668
OCCT-97530-OT SESSION BY LICENSED OT 113 448.500000 31340.4900 69.8785
OCCT-97530HM-OT SESSION BY OT ASST 120 553.750000 31617.3000 57.0967
OCCT-97530HMGT-OT SESSION BY OT ASST 3 9.750000 557.7000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 66 250.750000 17860.0000 71.2263
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 263 1296.750000 92047.4600 70.9832
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 14.500000 978.3200 67.4703
TRAV-TRAVS-Travel by mile 18 3731.000000 1660.2200 0.4450
Subtotal (Total Children Is Unduplicated) 608 10964.00000 268028.3800 24.4462
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Total 14144.750000 387849.9600 27.4201
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Number of Children (Unduplicated) With at Least One Service 879
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Center 51
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 1062 783.250000 32870.3300 0.0000
P 2125 9301.750000 160852.8600 160704.1100
D 14 12.500000 538.0000 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
3477 4045.250000 193442.3300 285.7600
Other 2 2.000000 146.4400 75.0000
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Total 6680 14144.750000 387849.9600 161064.8700