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
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 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 11 14.000000 679.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 22 41.750000 2087.5000 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 4 6.000000 450.0000 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 4 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 5.000000 277.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 23.000000 1725.0000 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) 69 122.250000 7466.0000 61.0716
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 69 75.500000 3750.0000 49.6689
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1 1.000000 50.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 339 157.000000 7850.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 9 4.500000 225.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 23 6.250000 156.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 326 134.250000 6712.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 4 2.000000 100.0000 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 141 91.500000 4537.5000 49.5902
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 18 74.000000 3700.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 8.000000 400.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 614 2170.000000 21700.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 16 105.750000 7554.7800 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 12 73.000000 5215.1200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 7 8.000000 571.5200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 75.750000 5411.5800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 4.000000 285.7600 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 36 22.750000 841.7500 37.0000
Subtotal (Total Children Is Unduplicated) 804 4911.250000 75629.8000 15.3993
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Total 7791.250000 160703.3000 20.6261
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Number of Children (Unduplicated) With at Least One Service 1310
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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 9 8.500000 405.9400 0.0000
11390 7759.000000 158765.4200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11427 7791.250000 160703.3000 18.5000