CMS/EIP Fiscal Report Center: 09
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 1722 5345.250000 197774.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 2.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1673 6086.000000 224932.2500 36.9590
Subtotal (Total Children Is Unduplicated) 1872 11433.75000 422706.5000 36.9701
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 12 22.000000 1650.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 11 21.000000 1575.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 13.500000 973.5000 72.1111
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 23 44.000000 2442.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 165 313.500000 23337.5000 74.4418
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 114 222.000000 16605.0000 74.7973
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 96 188.500000 14137.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 295 565.000000 30729.2900 54.3881
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 77.000000 5775.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 8 33.000000 1650.0000 50.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 399 1527.500000 100559.0400 65.8324
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 66.5000 66.5000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 72 119.500000 5962.5000 49.8954
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 44 75.000000 3750.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 114 160.500000 4012.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 13 14.000000 700.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 10 18.750000 937.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 5.500000 137.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 29.000000 1450.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 4 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 10.000000 500.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 4 4.000000 200.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 21.500000 1075.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 8 9.000000 450.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 7.000000 175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 793 5859.000000 292950.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 245 1227.000000 61350.0000 50.0000
INTR-T1013-INTERPRETER 50 96.750000 4837.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 33 188.000000 1880.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 140 899.000000 63377.5700 70.4979
OCCT-97530GT-OT SESSION BY LICENSED OT 22 114.750000 8197.7400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 6 40.500000 2893.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 163 1192.000000 84142.9300 70.5897
PHY-97110GT-PT SESSION BY LICENSED PT 30 120.500000 8608.5200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 378 3102.750000 220250.6900 70.9856
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 93 523.000000 37000.8900 70.7474
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 5 27.000000 1928.8800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 744 81128.00000 35627.4200 0.4392
Subtotal (Total Children Is Unduplicated) 1358 95003.00000 842792.4800 8.8712
-----------------------------------------------------------------------------------------------------------------------
Total 107964.250000 1366058.0200 12.6529
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1965
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 10.500000 370.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 769 824.000000 31310.2500 0.0000
P 11676 66647.250000 663319.8800 663731.7400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 177 301.000000 16675.0000 0.0000
T 4452 33198.000000 254777.9300 254133.1800
2171 6673.500000 378051.4600 0.0000
Other 157 310.000000 21553.5000 0.0000
---------------------------------------------------------
Total 19414 107964.250000 1366058.0200 917864.9200