CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 Page: 1
List order: No List
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 289 124.750000 4615.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 725 2188.250000 80872.7500 36.9577
Subtotal (Total Children Is Unduplicated) 916 2313.000000 85488.5000 36.9600
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 173 343.250000 17162.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 34 59.000000 4254.5400 72.1108
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 16.500000 1237.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 18.000000 999.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 60 108.500000 6021.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 11.500000 862.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 80.500000 6037.5000 75.0000
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 3.000000 150.0000 50.0000
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 281 674.750000 38956.2900 57.7344
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 97 113.750000 5687.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 101 128.250000 6412.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 56 52.000000 1300.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 52 82.500000 4125.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 75 119.250000 5962.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 14 13.250000 331.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 39 56.750000 2837.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 10 16.500000 825.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 4 4.750000 118.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 32 46.000000 2300.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 8 8.000000 400.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 57 74.750000 3737.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 31 51.500000 2575.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 10 11.500000 287.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 50 253.250000 12662.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 28 100.000000 5000.0000 50.0000
INTR-T1013-INTERPRETER 87 420.750000 21037.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 845 5912.000000 58548.0100 9.9032
OCCT-97530-OT SESSION BY LICENSED OT 4 18.000000 970.9200 53.9400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.750000 196.4600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 6 27.000000 1737.5600 64.3541
PHY-97110GT-PT SESSION BY LICENSED PT 4 27.000000 1928.8800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 31.000000 2214.6400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 10 34.000000 2253.0100 66.2650
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 49 66.250000 2451.2200 36.9995
TRAV-TRAVS-Travel by mile 450 37300.00000 16030.3700 0.4298
Subtotal (Total Children Is Unduplicated) 1093 44972.75000 161981.0700 3.6018
-----------------------------------------------------------------------------------------------------------------------
Total 47960.500000 286425.8600 5.9721
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1552
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 6732 31117.500000 111098.9700 111098.9700
D 604 3647.500000 10077.2900 0.0000
S 22 6.250000 231.2500 0.0000
H 1 0.250000 9.2500 0.0000
T 2917 10253.000000 47197.2900 47197.2900
4785 2909.000000 116812.8100 0.0000
Other 77 27.000000 999.0000 0.0000
---------------------------------------------------------
Total 15138 47960.500000 286425.8600 158296.2600