CMS/EIP Fiscal Report Center: 55
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
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 1137 1172.500000 43382.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 281 213.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1214 4131.250000 152800.7500 36.9866
Subtotal (Total Children Is Unduplicated) 1293 5516.750000 196183.2500 35.5614
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 19 34.000000 1700.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 49 79.000000 3950.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 150 299.423197 22456.7399 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 0.836800 62.7600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 115 228.736533 17155.2400 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 92.004267 6900.3200 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 37 74.000000 4107.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 22.000000 1650.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 8 8.000000 408.4000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 32 32.000000 1633.6000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 204.2000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 29 30.000000 1531.5000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 341 945.000797 64491.1999 68.2446
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 523.6000 523.6000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 9 8.750000 437.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 115 123.250000 6162.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 123 150.750000 3768.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 56 98.000000 4900.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 65 161.500000 4037.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 90 94.500000 4725.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 80 66.500000 1662.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 42.000000 1050.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 519 3559.500000 177975.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 34 34.000000 1700.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 823 7106.000000 71060.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 123 827.435890 59112.0200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 166 990.137065 56635.8400 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 9 12.000000 686.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 53 339.010079 24218.8800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 4 5.500000 392.9200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 52 338.221486 19332.7400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 259 1607.596009 114846.6586 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 16.500000 1164.4800 70.5745
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 9.000000 642.9600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.000000 55.5200 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 17 8.500000 314.5000 37.0000
TRAV-TRAVS-Travel by mile 122 5627.000000 2503.2700 0.4449
Subtotal (Total Children Is Unduplicated) 902 21235.15053 558138.9186 26.2837
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Total 27696.901326 818813.3685 29.5634
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Number of Children (Unduplicated) With at Least One Service 1309
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Center 55
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 1096 852.250000 34522.7800 129.5000
P 11121 14274.968622 262138.0500 278534.3500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 14.000000 1042.8800 0.0000
T 479 658.500000 8022.9900 8022.9900
13458 11893.182704 512841.6885 0.0000
Other 4 4.000000 244.9800 0.0000
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Total 26166 27696.901326 818813.3685 286686.8400