CMS/EIP Fiscal Report Center: 55
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
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 986 1451.250000 53687.0000 36.9936
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 10 4.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1082 3667.000000 135669.7500 36.9975
Subtotal (Total Children Is Unduplicated) 1123 5122.750000 189356.7500 36.9639
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 5 10.000000 500.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 49 67.000000 3350.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 129 258.000000 19350.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 47 94.000000 5217.0000 55.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 200 456.000000 30137.4500 66.0909
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 23 21.500000 1075.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 17 17.000000 425.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 23 21.500000 1075.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 17 17.000000 425.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 0.750000 37.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 26 154.250000 7712.5000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 52.750000 3768.4600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 43.500000 3107.6400 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 12 75.250000 5375.8600 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 5 21.750000 1553.8200 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 9 3.750000 138.7500 37.0000
TRAV-TRAVS-Travel by mile 1 38.000000 16.9100 0.4450
Subtotal (Total Children Is Unduplicated) 60 467.000000 24711.4400 52.9153
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Total 6045.750000 244205.6400 40.3929
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Number of Children (Unduplicated) With at Least One Service 1123
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Center 55
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 2270 1790.083333 77216.8400 92.5000
P 2088 1269.250000 49391.0700 50260.3900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 45 67.250000 4647.1900 0.0000
T 0 0.000000 0.0000 0.0000
4900 2918.329867 112887.7800 0.0000
Other 1 0.836800 62.7600 0.0000
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Total 9304 6045.750000 244205.6400 50352.8900