CMS/EIP Fiscal Report Center: 54
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/20/2020 Page: 1
List order: No List
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 900 792.500000 29285.5000 36.9533
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 117 85.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1427 5213.500000 192531.5000 36.9294
Subtotal (Total Children Is Unduplicated) 1454 6091.250000 221817.0000 36.4157
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 12 12.000000 582.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 3 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 16.500000 1237.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 11.500000 862.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 9 15.500000 1137.5000 73.3871
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 11 20.500000 1137.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 24.000000 1800.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 65 114.500000 8550.0000 74.6725
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 62 98.500000 7387.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 36 62.000000 4650.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 3.500000 194.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 132 234.000000 12987.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 11.000000 825.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 77 148.000000 11100.0000 75.0000
SCREEN-T1023-SCREENING 13 13.000000 650.0000 50.0000
Subtotal (Total Children Is Unduplicated) 230 801.000000 54209.2500 67.6770
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 20.000000 3373.2500 168.6625
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 56 51.250000 2562.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 88 100.000000 5000.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 4.750000 118.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 147 78.750000 3937.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 506 582.000000 29087.5000 49.9785
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.750000 43.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 70 29.000000 1450.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 384 182.000000 9100.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 82 43.750000 2187.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 191 99.000000 4950.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 44 19.500000 481.2500 24.6795
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 58 36.250000 1812.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 277 186.750000 9337.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 9 8.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 100 216.750000 10837.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 534 3318.000000 165900.6600 50.0002
INTR-T1013-INTERPRETER 18 69.750000 1743.7500 25.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 51 63.000000 630.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 2.500000 178.6000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 65 269.000000 19253.0800 71.5728
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 53 238.500000 17038.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 11 23.500000 1678.8400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 53 236.250000 16877.7000 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 2 2.000000 142.8800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 39 148.500000 10608.8400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 0.250000 17.8600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 72 314.000000 22432.1600 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 5 5.000000 357.2000 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 46 173.250000 12376.9800 71.4400
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 5 7.000000 97.1600 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 155 254.750000 9425.7500 37.0000
TRAV-TRAVS-Travel by mile 33 555.000000 246.9100 0.4449
Subtotal (Total Children Is Unduplicated) 901 7343.250000 363407.7500 49.4887
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Total 14235.500000 639434.0000 44.9183
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Number of Children (Unduplicated) With at Least One Service 1470
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Center 54
Flag Claims Units Chgs Paid
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R 7 4.500000 261.2100 0.0000
U 0 0.000000 0.0000 0.0000
B 2347 1928.250000 87149.7100 9.2500
P 1540 1245.750000 53983.9100 53846.8400
D 84 63.250000 3339.0100 9.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1497 1399.920000 41328.4900 41300.7400
13213 9565.830000 451405.7900 0.0000
Other 29 28.000000 1965.8800 0.0000
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Total 18717 14235.500000 639434.0000 95166.0800