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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 342 377.250000 13958.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 2.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 516 1183.500000 43752.5000 36.9687
Subtotal (Total Children Is Unduplicated) 576 1563.250000 57710.7500 36.9172
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 57 58.500000 4358.2500 74.5000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 13 13.000000 975.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 5.000000 375.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 75 77.500000 4301.2500 55.5000
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
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 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 84 163.000000 10525.7500 64.5752
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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 33 215.250000 3412.5000 15.8537
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 47 139.750000 6837.5000 48.9267
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 71 227.000000 2270.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 64.000000 4572.1600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 3 4.000000 285.7600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 5 9.000000 514.8000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 7 34.000000 1944.8000 57.2000
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 5 14.250000 1018.0200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 17 47.250000 3047.3700 64.4946
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 169.750000 11992.0600 70.6454
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 124 391.250000 27805.4900 71.0683
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 7 13.000000 928.7200 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 11 28.750000 2053.9000 71.4400
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.8800 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 0.750000 27.7500 37.0000
Subtotal (Total Children Is Unduplicated) 274 1365.750000 66945.6900 49.0175
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Total 3092.000000 135182.1900 43.7200
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Number of Children (Unduplicated) With at Least One Service 675
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Center 51
Flag Claims Units Chgs Paid
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R 15 8.000000 296.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 932 719.250000 28839.1700 0.0000
P 306 966.500000 41524.2900 41499.2900
D 15 13.000000 481.0000 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
1590 1385.250000 64041.7300 10.0000
Other 0 0.000000 0.0000 0.0000
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Total 2858 3092.000000 135182.1900 41509.2900