CMS/EIP Fiscal Report Center: 54
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
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 839 697.000000 25770.5000 36.9735
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 692 658.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 470 1402.750000 51837.0000 36.9538
Subtotal (Total Children Is Unduplicated) 1246 2757.750000 77607.5000 28.1416
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 14 17.000000 824.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 33 57.750000 2887.5000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 112.5000 56.2500
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 11.500000 862.5000 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 5 7.000000 525.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 17.000000 943.5000 55.5000
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 14 26.500000 1987.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 84 159.750000 9545.5000 59.7527
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 20.000000 1623.6300 81.1815
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 107 120.000000 5975.0000 49.7917
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 2 1.500000 75.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 3.250000 81.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 502 578.000000 28900.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 83 31.000000 1550.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 37 9.750000 243.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 328 137.250000 6862.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 5 3.000000 150.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 19 6.500000 156.2500 24.0385
CONPF-CONPF-CONSULT, PT, FACE TO FACE 185 97.500000 4875.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 16 7.000000 350.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 29 7.500000 187.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 143 93.500000 4637.5000 49.5989
CONSP-CONSP-CONSULT, SLP, PHONE 14 4.750000 118.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 660 1761.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 105 611.000000 30550.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 18 25.500000 1275.0000 50.0000
INTR-T1013-INTERPRETER 20 74.000000 1850.0000 25.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1073 6587.000000 65870.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 109.750000 7840.5400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 6 11.000000 785.8400 71.4400
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 15 82.000000 5858.0800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 7 8.000000 571.5200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 23 85.750000 6125.9800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 4.000000 285.7600 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 73 55.750000 2062.7500 37.0000
TRAV-TRAVS-Travel by mile 803 69067.00000 30699.3000 0.4445
Subtotal (Total Children Is Unduplicated) 1095 79603.50000 209618.1000 2.6333
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Total 82521.000000 296771.1000 3.5963
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Number of Children (Unduplicated) With at Least One Service 1418
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Center 54
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 1 0.250000 9.2500 0.0000
P 1 0.500000 18.5000 18.5000
D 26 23.000000 1504.1900 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 8797 55190.000000 103828.4900 103422.5500
13873 27307.250000 191410.6700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 22698 82521.000000 296771.1000 103441.0500