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
Payclass Filters:GR
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 584 284.250000 10517.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 869 3081.500000 114015.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1254 3365.750000 124532.7500 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 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 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 21 37.500000 2081.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 3.000000 225.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 38.500000 2887.5000 75.0000
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 35 91.500000 6080.8000 66.4568
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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-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 13.750000 687.5000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 2 13.000000 928.7200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 5.000000 357.2000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 21.000000 1500.2400 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 54 145.000000 5365.0000 37.0000
Subtotal (Total Children Is Unduplicated) 227 767.500000 34357.4100 44.7654
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Total 4224.750000 164970.9600 39.0487
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Number of Children (Unduplicated) With at Least One Service 1348
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 12 12.000000 650.7000 0.0000
S 17 8.000000 296.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6975 4204.750000 164024.2600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7004 4224.750000 164970.9600 0.0000