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
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
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-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 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 18 43.000000 2692.2000 62.6093
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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 100 159.750000 7987.5000 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 40.250000 2012.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 37 102.250000 5112.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 6 7.000000 350.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 567 3797.000000 37970.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 27.500000 1964.6000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 3 2.750000 196.4600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 11 59.000000 3374.8000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 2 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 12 31.750000 2268.2200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 82.250000 5875.9400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 2.750000 196.4600 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 10 6.750000 249.7500 37.0000
TRAV-TRAVS-Travel by mile 380 26539.00000 11807.6000 0.4449
Subtotal (Total Children Is Unduplicated) 598 31173.75000 94649.4800 3.0362
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Total 31217.250000 97360.1800 3.1188
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Number of Children (Unduplicated) With at Least One Service 600
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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 0 0.000000 0.0000 0.0000
T 3853 31168.750000 97310.7700 97220.7700
4 48.500000 49.4100 30.9100
Other 0 0.000000 0.0000 0.0000
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Total 3857 31217.250000 97360.1800 97251.6800