CMS/EIP Fiscal Report Center: 09
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 1806 5280.500000 195360.0000 36.9965
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1825 7020.250000 259721.5000 36.9960
Subtotal (Total Children Is Unduplicated) 2016 12301.25000 455081.5000 36.9947
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 13.000000 975.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 17.000000 943.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 93 164.000000 12210.0000 74.4512
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 52 94.500000 7037.5000 74.4709
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 20 35.000000 2575.0000 73.5714
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 178 330.500000 17917.2700 54.2126
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 271 690.000000 43860.4200 63.5658
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 17 26.000000 1300.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 22 22.500000 562.5000 25.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 1.000000 50.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 3 3.000000 150.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 2 3.000000 150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 13 10.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 21 29.000000 1450.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 41 141.000000 7050.0000 50.0000
INTR-T1013-INTERPRETER 47 111.750000 5587.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 5 19.750000 1410.9400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 8 27.000000 1928.8800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 68.750000 4911.5000 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 23.000000 1643.1200 71.4400
Subtotal (Total Children Is Unduplicated) 146 494.500000 26562.3200 53.7155
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Total 13485.750000 525504.2400 38.9674
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Number of Children (Unduplicated) With at Least One Service 2020
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Center 09
Flag Claims Units Chgs Paid
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R 39 50.500000 2146.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 593 638.000000 24876.2500 0.0000
P 10435 9390.000000 364596.8500 364824.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 90 144.000000 8012.2500 0.0000
T 3 13.000000 481.0000 425.5000
3717 3250.250000 125391.3900 9.2500
Other 0 0.000000 0.0000 0.0000
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Total 14877 13485.750000 525504.2400 365259.5000