CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 Page: 1
List order: No List
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 1343 842.000000 31154.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 37 25.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1986 6189.750000 229020.7500 37.0000
Subtotal (Total Children Is Unduplicated) 2094 7057.000000 260174.7500 36.8676
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 9 14.500000 725.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 83.2500 55.5000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 50 86.500000 6487.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 167 282.000000 21111.0000 74.8617
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 27.000000 2025.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 43 73.500000 5512.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 24.500000 1837.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 71 124.000000 9300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 48 85.000000 4717.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 144 247.000000 13747.5000 55.6579
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
Subtotal (Total Children Is Unduplicated) 290 977.500000 66349.2500 67.8765
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 31 29.500000 1450.0000 49.1525
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 7 7.000000 350.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 34 30.250000 756.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 3.000000 118.7500 39.5833
CONIP-CONIP-CONSULT, ITDS PHONE 10 13.000000 275.0000 21.1538
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 7 9.250000 181.2500 19.5946
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 9.000000 225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 733 4579.250000 228362.5000 49.8690
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 301 1306.500000 65155.0000 49.8699
INTR-T1013-INTERPRETER 9 98.000000 7420.0000 75.7143
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 882 6202.000000 61980.0000 9.9936
OCCT-97530-OT SESSION BY LICENSED OT 53 223.500000 15529.6500 69.4839
OCCT-97530GT-OT SESSION BY LICENSED OT 17 66.500000 4462.3400 67.1029
OCCT-97530HM-OT SESSION BY OT ASST 11 22.750000 1301.3000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 7 15.750000 900.9000 57.2000
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 0.500000 35.7200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 79 286.250000 19880.6000 69.4519
PHY-97110GT-PT SESSION BY LICENSED PT 31 69.500000 4827.4400 69.4596
PHY-97110HM-PT SESSION BY PT ASST 11 31.500000 1800.5400 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 3 2.000000 114.3200 57.1600
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 151 565.500000 38262.9000 67.6621
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 68 213.750000 15086.9700 70.5823
SPL-92508-GROUP SPL SESSION PER CHILD 4 70.000000 777.2800 11.1040
Subtotal (Total Children Is Unduplicated) 1136 13860.75000 469477.2100 33.8710
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Total 21895.250000 796001.2100 36.3550
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Number of Children (Unduplicated) With at Least One Service 2191
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Center 06
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 7714 7263.750000 180513.3300 180513.3300
D 0 0.000000 0.0000 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
20119 14631.500000 615487.8800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 27833 21895.250000 796001.2100 180513.3300