CMS/EIP Fiscal Report Center: 51
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 331 357.750000 13236.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 2.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 228 496.750000 18342.7500 36.9255
Subtotal (Total Children Is Unduplicated) 450 857.000000 31579.5000 36.8489
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 25 25.000000 1875.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 4.000000 300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 3.000000 225.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 29 29.000000 1609.5000 55.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 36 64.000000 4162.6500 65.0414
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 62.0400 62.0400
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 6.2500 6.2500
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 12.5000 6.2500
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 169.250000 1112.5000 6.5731
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 23 65.250000 3112.5000 47.7011
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 71 227.000000 2270.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 8.000000 571.5200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 4 8.000000 457.6000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 5 25.000000 1430.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 3 7.500000 535.8000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 11 25.250000 1768.1400 70.0253
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 67.000000 4716.7900 70.3999
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 49 163.250000 11624.3300 71.2057
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 0.750000 27.7500 37.0000
Subtotal (Total Children Is Unduplicated) 154 772.000000 27776.4700 35.9799
-----------------------------------------------------------------------------------------------------------------------
Total 1693.000000 63518.6200 37.5184
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 519
-----------------------------------------------------------------------------------------------------------------------
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 238 776.000000 28333.9100 28333.9100
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
1357 917.000000 35184.7100 10.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1595 1693.000000 63518.6200 28343.9100