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
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 986 1451.250000 53687.0000 36.9936
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 10 4.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 315 1072.250000 39664.0000 36.9914
Subtotal (Total Children Is Unduplicated) 1026 2528.000000 93351.0000 36.9268
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 3 7.000000 350.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 39 55.000000 2750.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 16.836800 1262.7600 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 28.000000 1554.0000 55.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 1.118511 57.1000 51.0500
Subtotal (Total Children Is Unduplicated) 67 113.955311 6373.8600 55.9330
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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-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 51.250000 2562.5000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 7.000000 500.0800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 4.500000 321.4800 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) 38 181.500000 6539.7200 36.0315
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Total 2823.455311 106264.5800 37.6364
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Number of Children (Unduplicated) With at Least One Service 1030
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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 0 0.000000 0.0000 0.0000
P 5 2.000000 74.0000 91.2200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 3.250000 209.2500 0.0000
T 0 0.000000 0.0000 0.0000
4778 2818.205311 105981.3300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4786 2823.455311 106264.5800 91.2200