CMS/EIP Fiscal Report Center: 03
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 680 398.500000 14744.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6 6.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 405 1199.500000 44381.5000 37.0000
Subtotal (Total Children Is Unduplicated) 833 1604.000000 59126.0000 36.8616
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 3 6.000000 300.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 8.500000 637.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 39 77.000000 5775.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 19 32.500000 2437.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 8.500000 637.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 21 40.000000 2220.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 29.000000 2175.0000 75.0000
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 71 221.500000 15471.9000 69.8506
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 0.750000 37.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 83 93.000000 4650.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 3.750000 93.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 4.000000 200.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 150 256.250000 12812.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 3 2.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 6 24.750000 1237.5000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 1 4.750000 339.3400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 2.500000 178.6000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 33.250000 2375.3800 71.4400
TRAV-TRAVS-Travel by mile 1 29.000000 12.9000 0.4448
Subtotal (Total Children Is Unduplicated) 199 456.000000 22012.4700 48.2730
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Total 2281.500000 96610.3700 42.3451
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Number of Children (Unduplicated) With at Least One Service 941
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Center 03
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 0 0.000000 0.0000 0.0000
3830 2281.500000 96610.3700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3830 2281.500000 96610.3700 0.0000