CMS/EIP Fiscal Report Center: 57
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 591 366.000000 13542.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 321 263.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1815 7827.500000 289617.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1835 8456.750000 303159.5000 35.8482
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 125 140.250000 7012.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 20.500000 1537.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 26.000000 1443.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 228 252.000000 18900.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 30 55.500000 4162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 108 119.000000 8925.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 355 449.500000 24947.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 10.500000 787.5000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 28 28.000000 1429.4000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 23 23.000000 1174.1500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 545 1138.750000 71262.6000 62.5797
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 13.500000 675.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 128 128.000000 6400.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 13.000000 650.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 267 266.000000 13300.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 2 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 4.000000 100.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 16 613.000000 15325.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1372 10743.50000 537175.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 142 174.500000 8725.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1388 11437.00000 114370.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 23 118.500000 8465.6400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 4 19.000000 1086.8000 57.2000
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 33 130.500000 9322.9200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 16 104.500000 5973.2200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 58 281.250000 20092.5000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 214.3200 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.500000 200.2000 57.2000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 191 193.000000 7141.0000 37.0000
TRAV-TRAVS-Travel by mile 37 11993.00000 5336.7300 0.4450
Subtotal (Total Children Is Unduplicated) 1434 36243.75000 754824.7700 20.8263
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Total 45839.250000 1129246.8700 24.6349
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Number of Children (Unduplicated) With at Least One Service 1934
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Center 57
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 355 366.000000 15413.5000 18.5000
P 4684 4752.500000 190180.0800 187944.5020
D 14 7.000000 259.0000 0.0000
S 302 487.500000 11121.0400 11121.0400
H 16 15.750000 611.5000 75.0000
T 6176 27905.500000 361655.8200 361655.8200
7388 12232.250000 548618.1800 383628.6800
Other 44 72.750000 1387.7500 1387.7500
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Total 18979 45839.250000 1129246.8700 945831.2920