CMS/EIP Fiscal Report Center: 07
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 1501 2174.750000 80282.7500 36.9159
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 70 78.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1448 3732.750000 137945.7500 36.9555
Subtotal (Total Children Is Unduplicated) 1702 5985.500000 218228.5000 36.4595
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 79 114.000000 5700.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 66 132.000000 9715.0000 73.5985
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 25 50.000000 3750.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 58.000000 4350.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 129 258.000000 14319.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 49 97.000000 5383.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 104 217.500000 16312.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 87.500000 6562.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 371 1049.000000 68202.2500 65.0164
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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 33 33.500000 1675.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 38 37.750000 1887.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 23 19.500000 487.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 112 149.500000 7475.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 104 200.000000 10000.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 49 56.250000 2812.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 41 51.250000 2562.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 30 42.750000 2137.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 20 30.750000 1537.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 48 56.500000 2825.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 67 101.000000 5050.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 53 81.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 227 1099.750000 54987.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 75 318.500000 15925.0000 50.0000
INTR-T1013-INTERPRETER 2 7.000000 370.0000 52.8571
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 895 5813.000000 58240.0000 10.0189
OCCT-97530-OT SESSION BY LICENSED OT 23 98.000000 6431.2200 65.6247
OCCT-97530GT-OT SESSION BY LICENSED OT 6 15.000000 1033.4900 68.8993
PHY-97110-PT SESSION BY LICENSED PT 13 84.000000 5822.4600 69.3150
PHY-97110GT-PT SESSION BY LICENSED PT 2 3.000000 214.3200 71.4400
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 343.000000 21489.1100 62.6505
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 57.500000 3851.2800 66.9788
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 8.500000 482.4700 56.7612
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 14 21.500000 795.5000 37.0000
TRAV-TRAVS-Travel by mile 22 2630.000000 1170.1200 0.4449
Subtotal (Total Children Is Unduplicated) 1003 11366.50000 209460.9700 18.4279
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Total 18401.000000 495891.7200 26.9492
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Number of Children (Unduplicated) With at Least One Service 1826
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Center 07
Flag Claims Units Chgs Paid
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R 14 20.500000 1366.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 696 558.750000 22017.2500 0.0000
P 6434 13821.000000 319763.9700 319490.1700
D 18 18.500000 988.5000 0.0000
S 1 1.000000 50.0000 0.0000
H 40 79.500000 5905.5000 0.0000
T 0 0.000000 0.0000 0.0000
7229 3901.750000 145800.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 14432 18401.000000 495891.7200 319490.1700