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
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 289 124.750000 4615.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2210 6582.500000 243460.0000 36.9859
Subtotal (Total Children Is Unduplicated) 2217 6707.250000 248075.7500 36.9862
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 17.500000 1312.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 11.000000 825.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 21 46.500000 3487.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 7 14.500000 1087.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 11 22.000000 1221.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 19.500000 1462.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 86 135.500000 10162.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 15.500000 1162.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 44 71.000000 5325.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 14.000000 777.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 147 254.000000 14097.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 31.000000 2325.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 145 251.000000 18825.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 388 923.000000 63444.9500 68.7378
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 41 49.250000 2462.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 9 11.750000 587.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 21 19.250000 481.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 16 20.500000 1025.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 4 5.000000 250.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 5.000000 125.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 25 29.750000 1487.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 21 25.000000 1250.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 42 53.750000 2687.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 2 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 8.000000 200.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 36 125.000000 6250.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 92 292.750000 14637.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 27 65.000000 4643.6000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 34 92.500000 6608.2000 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 1 0.750000 53.5800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 30 70.000000 5000.8000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 30 85.250000 6090.2600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 103.250000 7376.1800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 43 117.250000 8376.3400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 19 27.500000 1017.5000 37.0000
Subtotal (Total Children Is Unduplicated) 285 1215.500000 71028.0900 58.4353
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Total 8845.750000 382548.7900 43.2466
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Number of Children (Unduplicated) With at Least One Service 2221
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Center 01
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 8 2.000000 74.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 4 4.750000 175.7500 0.0000
S 3524 2253.500000 101139.4200 0.0000
H 5765 3541.750000 153741.4300 117907.7500
T 1 0.250000 9.2500 0.0000
4922 2978.750000 124937.1900 0.0000
Other 177 64.750000 2471.7500 0.0000
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Total 14401 8845.750000 382548.7900 117907.7500