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
Agency Filter:EIP DEI DEIP
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 11 11.000000 533.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 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 1 2.000000 150.0000 75.0000
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 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 6 10.500000 582.7500 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 12 23.500000 1762.5000 75.0000
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 51 106.500000 7366.2500 69.1667
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 49 41.250000 2062.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 47 54.500000 2725.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 81 35.000000 1750.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 376 231.250000 11550.0000 49.9459
CONOF-CONOF-CONSULT, OT, FACE TO FACE 70 29.000000 1450.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 377 173.000000 8650.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 80 41.750000 2087.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 189 97.000000 4850.0000 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 277 186.500000 9325.0000 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 1 1.000000 50.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 66.500000 3325.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 17 28.000000 280.0000 10.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 18 66.250000 4732.9000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 3.750000 267.9000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 17 113.500000 8108.4400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 17 49.250000 3518.4200 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 82 109.500000 4051.5000 37.0000
Subtotal (Total Children Is Unduplicated) 660 1393.250000 71127.9100 51.0518
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Total 3955.000000 166036.1600 41.9813
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Number of Children (Unduplicated) With at Least One Service 1145
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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 1 0.750000 27.7500 0.0000
7157 3953.500000 165980.6600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7161 3955.000000 166036.1600 27.7500