CMS/EIP Fiscal Report Center: 05
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 Page: 1
List order: No List
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 381 150.000000 5550.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4 3.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 422 1281.750000 47424.7500 37.0000
Subtotal (Total Children Is Unduplicated) 663 1434.750000 52974.7500 36.9226
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.000000 525.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 7.500000 562.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 41.000000 2275.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 21 34.500000 1914.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 24 44.500000 3337.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 23.000000 1725.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 18.500000 1026.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 17 33.000000 1831.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 115 249.500000 15987.4500 64.0780
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 36 27.750000 1387.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 65 65.000000 3250.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 32 20.750000 1037.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 44 28.000000 1400.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 8 4.000000 100.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 3.750000 187.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 16 10.750000 537.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 7 3.250000 81.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 2.500000 125.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 8 5.500000 275.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 6 3.500000 87.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 18 15.750000 787.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 27 15.500000 775.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.500000 62.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 128 483.000000 24150.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 134 513.750000 25687.5000 50.0000
INTR-T1013-INTERPRETER 2 4.000000 200.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 412 1728.000000 17280.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 31.750000 2034.9500 64.0929
OCCT-97530GT-OT SESSION BY LICENSED OT 22 86.500000 5383.6500 62.2387
PHY-97110-PT SESSION BY LICENSED PT 2 6.000000 428.6400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 13 35.500000 2216.6600 62.4411
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 40.000000 2375.3900 59.3848
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 42 135.500000 8043.9800 59.3652
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 27 49.750000 1840.7500 37.0000
TRAV-TRAVS-Travel by mile 414 30704.00000 13659.9300 0.4449
Subtotal (Total Children Is Unduplicated) 551 34026.75000 113407.7000 3.3329
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Total 35711.000000 182369.9000 5.1068
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Number of Children (Unduplicated) With at Least One Service 869
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Center 05
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 3284 32139.750000 123491.2900 123491.2900
D 34 23.250000 917.2500 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
2721 3548.000000 57961.3600 5791.3600
Other 0 0.000000 0.0000 0.0000
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Total 6039 35711.000000 182369.9000 129282.6500