CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/20/2020 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 753 808.750000 29923.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 763 949.250000 35122.2500 37.0000
Subtotal (Total Children Is Unduplicated) 882 1758.000000 65046.0000 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 23 28.000000 1400.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 35 66.500000 4987.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 33 64.500000 4837.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 54 105.500000 5855.2500 55.5000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 22.8300 22.8300
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 23 24.000000 1200.0000 50.0000
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 337.3500 48.1929
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 124 320.000000 20052.7800 62.6649
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 2525.0900 841.6967
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 27 34.750000 1737.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 31 36.500000 1825.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 8 7.500000 187.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 29 39.250000 1962.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 80 74.250000 3712.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.500000 62.5000 25.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 21 14.500000 725.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 66 59.250000 2962.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 52 202.000000 10100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 127 681.250000 34062.5000 50.0000
INTR-T1013-INTERPRETER 11 25.000000 1250.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 178 764.000000 7640.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 30.750000 2099.6200 68.2803
OCCT-97530GT-OT SESSION BY LICENSED OT 10 55.000000 3551.1300 64.5660
PHY-97110-PT SESSION BY LICENSED PT 19 38.250000 2406.2000 62.9072
PHY-97110GT-PT SESSION BY LICENSED PT 12 39.250000 2620.7900 66.7717
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 32 182.000000 12977.9300 71.3073
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 19 120.500000 8508.5200 70.6101
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 46 54.000000 1998.0000 37.0000
TRAV-TRAVS-Travel by mile 40 3122.000000 1388.9800 0.4449
Subtotal (Total Children Is Unduplicated) 376 5595.500000 105200.7600 18.8010
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Total 7673.500000 190299.5400 24.7996
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Number of Children (Unduplicated) With at Least One Service 1013
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Center 02
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1333 2261.750000 52752.7500 52752.7500
1099 3043.750000 38247.2900 0.0000
Other 4638 2368.000000 99299.5000 0.0000
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Total 7070 7673.500000 190299.5400 52752.7500