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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 882 734.500000 27158.0000 36.9748
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 815 789.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1643 5706.500000 210816.7500 36.9433
Subtotal (Total Children Is Unduplicated) 1678 7230.500000 237974.7500 32.9126
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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 35 60.750000 3037.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 18.500000 1387.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 13.000000 937.5000 72.1154
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 25 40.000000 2220.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 2.500000 138.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 124 205.000000 15375.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 14.000000 1050.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 83 116.000000 8662.5000 74.6767
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 20 27.000000 2025.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 57 84.500000 6337.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 202 307.500000 17066.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 28.500000 1581.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 94 163.500000 12225.0000 74.7706
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 18.000000 1350.0000 75.0000
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
Subtotal (Total Children Is Unduplicated) 405 1152.250000 76706.2500 66.5708
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 21.000000 2710.5700 129.0748
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 503 579.250000 28962.5000 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 329 137.500000 6875.0000 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 186 98.500000 4925.0000 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 771 1880.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 714 4637.500000 221937.5000 47.8571
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 104 140.750000 7037.5000 50.0000
INTR-T1013-INTERPRETER 20 74.000000 1850.0000 25.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1192 6826.000000 68260.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 111 536.500000 38274.1200 71.3404
OCCT-97530GT-OT SESSION BY LICENSED OT 37 56.500000 4036.3600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 3 4.000000 228.8000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 3 3.000000 214.3200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 92 368.500000 26325.6400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 22 28.000000 2000.3200 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 100 438.250000 31308.5800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 32 46.250000 3304.1000 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.000000 57.2000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 142.8800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 3 3.000000 41.6400 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 73 55.750000 2062.7500 37.0000
TRAV-TRAVS-Travel by mile 878 70239.00000 31220.6200 0.4445
Subtotal (Total Children Is Unduplicated) 1214 86467.50000 495500.4800 5.7305
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Total 94850.250000 810181.4800 8.5417
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Number of Children (Unduplicated) With at Least One Service 1700
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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 1418 1201.000000 56547.8000 157.2500
P 5349 4236.355924 185482.1900 191419.5700
D 363 332.394076 21577.5700 3.3000
S 0 0.000000 0.0000 0.0000
H 4 3.250000 126.7500 34.2500
T 9217 56506.380000 121111.5200 120705.5800
18666 32466.120000 418500.1700 0.0000
Other 108 104.750000 6835.4800 0.0000
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Total 35125 94850.250000 810181.4800 312319.9500