CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2019 ending 06/30/2020 Date of Report:07/20/2020 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 224 452.500000 16742.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 207 304.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 267 1442.250000 53344.7500 36.9872
Subtotal (Total Children Is Unduplicated) 268 2198.750000 70087.2500 31.8760
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.000000 562.5000 70.3125
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 25.000000 1387.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 40.000000 3000.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 18.000000 1350.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 39 59.500000 4462.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 14 22.000000 1650.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 32 49.500000 3712.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 149 235.000000 13042.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 44 73.000000 4051.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 92 160.000000 12000.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 47.500000 3562.5000 75.0000
Subtotal (Total Children Is Unduplicated) 254 773.500000 51452.2500 66.5187
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 3.250000 162.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 2.250000 112.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.500000 125.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 1.500000 75.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 179 212.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 26.000000 1300.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 202 420.000000 4200.0000 10.0000
PHY-97110-PT SESSION BY LICENSED PT 2 4.000000 285.7600 71.4400
TRAV-TRAVS-Travel by mile 69 1893.000000 842.1700 0.4449
Subtotal (Total Children Is Unduplicated) 202 2565.000000 7102.9300 2.7692
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Total 5537.250000 128642.4300 23.2322
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Number of Children (Unduplicated) With at Least One Service 271
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Center 53
Flag Claims Units Chgs Paid
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R 8 9.000000 360.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 224 242.250000 11133.7500 0.0000
P 943 999.170000 45664.0000 47366.0000
D 68 73.080000 3902.5700 0.0000
S 1 0.500000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 215 2033.500000 3818.9200 3818.9200
2574 2153.000000 62035.1900 0.0000
Other 22 26.750000 1727.2500 0.0000
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Total 4055 5537.250000 128642.4300 51184.9200