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
Agency Filter:EIP DEI DEIP
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 13 18.000000 900.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 40 63.000000 3150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 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 110 219.029866 16427.2399 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 0.836800 62.7600 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 0.133333 10.0000 75.0002
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 22.000000 1650.0000 75.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 189 346.999999 23769.3999 68.4997
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.000000 100.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 28 26.500000 1325.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 10 6.750000 168.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 28 26.500000 1325.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 9 6.500000 162.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 72 352.250000 17612.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 20 19.000000 950.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 19.000000 1357.3600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 7.750000 539.3800 69.5974
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 9.000000 642.9600 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 17 8.500000 314.5000 37.0000
Subtotal (Total Children Is Unduplicated) 76 484.750000 24507.9500 50.5579
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Total 6348.499999 244460.5999 38.5068
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Number of Children (Unduplicated) With at Least One Service 1293
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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 3345 2423.000000 96158.4900 112554.7900
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 0 0.000000 0.0000 0.0000
5390 3055.249999 112491.4699 0.0000
Other 4 4.000000 244.9800 0.0000
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Total 9843 6348.499999 244460.5999 112684.2900