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
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 381 150.000000 5550.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4 3.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1088 3196.000000 118252.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1093 3349.000000 123802.0000 36.9669
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 11.500000 862.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 9.000000 675.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 33 52.000000 3900.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 56 81.000000 6075.0000 75.0000
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.500000 125.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 2.000000 20.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 0.750000 53.5800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 5 20.000000 1428.8000 71.4400
Subtotal (Total Children Is Unduplicated) 11 29.750000 1861.3200 62.5654
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Total 3459.750000 131738.3200 38.0774
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Number of Children (Unduplicated) With at Least One Service 1093
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Center 05
Flag Claims Units Chgs Paid
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R 26 31.000000 1934.3200 0.0000
U 0 0.000000 0.0000 0.0000
B 3054 1930.750000 72554.9000 41748.7500
P 38 56.000000 3879.1000 3879.1000
D 35 24.750000 1029.7500 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
2510 1417.250000 52340.2500 50.0000
Other 0 0.000000 0.0000 0.0000
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Total 5663 3459.750000 131738.3200 45677.8500