CMS/EIP Fiscal Report Center: 54
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 900 792.000000 29267.0000 36.9533
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 117 85.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 442 1578.000000 58275.0000 36.9297
Subtotal (Total Children Is Unduplicated) 1090 2455.250000 87542.0000 35.6550
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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 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 6.500000 487.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.500000 637.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.000000 825.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 13 20.000000 1500.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 27 46.500000 2580.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 26.000000 1950.0000 75.0000
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 57 156.500000 10279.2500 65.6821
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 12 18.000000 2346.4900 130.3606
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 7 14.000000 700.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 83 548.500000 27425.0000 50.0000
INTR-T1013-INTERPRETER 18 69.750000 1743.7500 25.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 51 63.000000 630.0000 10.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 19 76.250000 5447.3000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 3.750000 267.9000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 18 119.500000 8537.0800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 17 49.250000 3518.4200 71.4400
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) 743 3197.000000 130407.3500 40.7905
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Total 5808.750000 228228.6000 39.2905
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Number of Children (Unduplicated) With at Least One Service 1171
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Center 54
Flag Claims Units Chgs Paid
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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 3 0.750000 27.7500 27.7500
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 1357 1260.750000 32978.1000 32950.3500
8025 4547.250000 195222.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9385 5808.750000 228228.6000 32978.1000