CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 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 584 284.500000 10526.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2315 9164.000000 339068.0000 37.0000
Subtotal (Total Children Is Unduplicated) 2338 9448.500000 349594.5000 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 12 20.000000 1500.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 16.000000 1200.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 10.000000 555.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 125 209.000000 11599.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 13.000000 975.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 165 334.500000 25087.5000 75.0000
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 240 638.000000 43330.4500 67.9161
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.000000 100.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 53 66.750000 3337.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 48 56.000000 1400.0000 25.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 39 90.250000 4512.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 9 25.500000 637.5000 25.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 44 89.750000 4487.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 6 6.500000 162.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 2.500000 125.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 43 76.250000 3812.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 63 122.500000 6125.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 21 28.750000 718.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9 19.750000 987.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 103 643.000000 32150.0000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 41 267.500000 19110.2000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.750000 125.0200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 2 2.000000 142.8800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 34 244.750000 17484.9400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 55 339.750000 24271.7400 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 54 145.000000 5365.0000 37.0000
Subtotal (Total Children Is Unduplicated) 306 2234.250000 125227.4700 56.0490
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Total 12320.750000 518152.4200 42.0553
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Number of Children (Unduplicated) With at Least One Service 2341
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Center 01
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 0.750000 27.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 15 14.500000 812.0800 0.0000
S 4229 2768.750000 113080.5400 0.0000
H 7235 5023.250000 221323.0300 185874.3100
T 0 0.000000 0.0000 0.0000
7266 4509.000000 182609.5200 0.0000
Other 3 4.500000 299.5000 0.0000
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Total 18749 12320.750000 518152.4200 185874.3100