CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2020 ending 09/30/2020 Date of Report:10/15/2020 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 896 1677.500000 62058.2500 36.9945
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 12 8.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1141 3071.000000 113517.7500 36.9644
Subtotal (Total Children Is Unduplicated) 1211 4757.250000 175576.0000 36.9070
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 11.500000 862.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 14.500000 804.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 42.500000 3187.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 46 86.500000 6487.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 9.000000 675.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 45 85.000000 6375.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 15 27.500000 2062.5000 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 109 204.500000 11294.2500 55.2286
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 82 157.500000 11812.5000 75.0000
SCREEN-T1023-SCREENING 2 4.000000 200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 202 670.500000 45822.5000 68.3408
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 0.500000 25.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 12 8.750000 437.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 26 12.000000 600.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 256 264.250000 13212.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 3.250000 75.0000 23.0769
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 7.000000 350.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 211 142.500000 7125.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 25 12.250000 612.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 143 71.750000 3587.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 18 8.000000 400.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 232 210.000000 10487.5000 49.9405
CONSP-CONSP-CONSULT, SLP, PHONE 3 2.500000 62.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 3 6.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 19.000000 950.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 183 909.750000 45487.5000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 26 107.000000 7644.0800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 39 197.250000 14091.5400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 15 103.750000 7411.9000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 31 151.250000 10805.3000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 41 193.500000 13787.9200 71.2554
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 41 232.250000 16591.9400 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 61 70.000000 2590.0000 37.0000
Subtotal (Total Children Is Unduplicated) 492 2733.500000 156360.1800 57.2015
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Total 8161.250000 377758.6800 46.2869
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Number of Children (Unduplicated) With at Least One Service 1243
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Center 53
Flag Claims Units Chgs Paid
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R 18 10.500000 414.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 3267 2886.500000 137832.3000 0.0000
P 1277 1125.000000 54021.4000 53993.6500
D 51 43.000000 2060.3300 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6818 4003.500000 177788.6000 0.0000
Other 93 92.750000 5641.5500 9.2500
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Total 11524 8161.250000 377758.6800 54002.9000