CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2019 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 2264 6311.250000 233368.2500 36.9765
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1402 2094.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 758 3047.000000 112646.0000 36.9695
Subtotal (Total Children Is Unduplicated) 2448 11453.00000 346014.2500 30.2117
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 4 5.000000 250.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 17 20.750000 1037.5000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 18.500000 1387.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 20.500000 1537.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 15.500000 1162.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 33 50.000000 2775.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 16.000000 888.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 45.000000 3375.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
SCREEN-T1023-SCREENING 5 9.000000 450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 111 232.250000 15158.5000 65.2680
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 62 52.500000 2625.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 10 9.000000 450.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 18 13.500000 337.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 493 602.500000 30100.0000 49.9585
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 256 226.000000 11300.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 36 20.000000 500.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 367 323.250000 16162.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 191 136.500000 6825.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 74 39.000000 975.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 329 267.750000 13387.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 125 53.750000 2687.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 4.500000 112.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 385 358.250000 17887.5000 49.9302
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 234 224.750000 11225.0000 49.9444
CONSP-CONSP-CONSULT, SLP, PHONE 34 18.750000 468.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1014 5418.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 38.000000 950.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 41 183.500000 9175.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 33.500000 1675.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1062 8401.000000 83990.0000 9.9976
OCCT-97530-OT SESSION BY LICENSED OT 9 33.000000 2357.5200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 3 5.000000 357.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 21.000000 1500.2400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 94.500000 6751.0800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 24.000000 1714.5600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 88 183.500000 6789.5000 37.0000
TRAV-TRAVS-Travel by mile 16 503.000000 223.7400 0.4448
Subtotal (Total Children Is Unduplicated) 1174 17290.25000 230612.9100 13.3377
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Total 28975.500000 591785.6600 20.4237
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Number of Children (Unduplicated) With at Least One Service 2473
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Center 53
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 1 0.500000 18.5000 0.0000
P 4 2.250000 46.2500 27.7500
D 182 187.750000 8011.3300 0.0000
S 3 3.000000 37.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 9 17.500000 451.9500 4.4500
39566 28764.500000 583220.6300 37.0000
Other 0 0.000000 0.0000 0.0000
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Total 39765 28975.500000 591785.6600 69.2000