CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.500000 18.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1 0.500000 18.5000 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 16.000000 1200.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 28.000000 1554.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 48.500000 3637.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 60 122.000000 9000.0000 73.7705
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 32.000000 2100.0000 65.6250
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 94 192.000000 10434.0000 54.3438
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 36.000000 2700.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
SCREEN-T1023-SCREENING 33 34.000000 1650.0000 48.5294
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 15 15.000000 765.7500 51.0500
Subtotal (Total Children Is Unduplicated) 197 559.000000 35271.6000 63.0977
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 95 105.750000 5262.5000 49.7636
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 8 6.500000 162.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 101 160.750000 8037.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 2 3.250000 162.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 10 9.250000 231.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 94 166.250000 8312.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 5 4.750000 237.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 13.000000 650.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 32 41.250000 2062.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 268 1359.000000 67850.0000 49.9264
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 49 50.500000 2525.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 567 3798.000000 37980.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 95 420.000000 29419.0400 70.0453
OCCT-97530GT-OT SESSION BY LICENSED OT 5 4.750000 339.3400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 38 215.500000 12326.6000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 7 7.750000 443.3000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 69 426.750000 28968.9200 67.8826
PHY-97110GT-PT SESSION BY LICENSED PT 8 8.250000 517.9400 62.7806
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 167 964.750000 67752.4300 70.2280
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 22 22.750000 1625.2600 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 10 6.750000 249.7500 37.0000
TRAV-TRAVS-Travel by mile 380 26570.00000 11821.3900 0.4449
Subtotal (Total Children Is Unduplicated) 600 34372.50000 287123.7200 8.3533
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Total 34932.000000 322413.8200 9.2298
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Number of Children (Unduplicated) With at Least One Service 610
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Center 52
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 4439 32269.500000 165747.9600 165443.6400
1361 2660.500000 156515.8600 383.3600
Other 0 0.000000 0.0000 0.0000
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Total 5801 34932.000000 322413.8200 165827.0000