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
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 896 1677.500000 62058.2500 36.9945
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 12 8.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 290 793.000000 29323.2500 36.9776
Subtotal (Total Children Is Unduplicated) 984 2479.250000 91381.5000 36.8585
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 8.000000 600.0000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 10 32.500000 2178.5000 67.0308
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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 12 6.000000 300.0000 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
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 16.500000 825.0000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 3 8.000000 571.5200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 2 5.750000 410.7800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 16.000000 1143.0400 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 61 70.000000 2590.0000 37.0000
Subtotal (Total Children Is Unduplicated) 346 864.000000 42465.3400 49.1497
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Total 3375.750000 136025.3400 40.2949
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Number of Children (Unduplicated) With at Least One Service 1024
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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 0 0.000000 0.0000 0.0000
P 1 0.750000 27.7500 9.2500
D 19 12.250000 453.2500 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
6243 3362.750000 135544.3400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6263 3375.750000 136025.3400 9.2500