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
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 1722 5344.750000 197755.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 2.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 650 2449.750000 90529.7500 36.9547
Subtotal (Total Children Is Unduplicated) 1778 7797.000000 288285.5000 36.9739
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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 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 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 42 82.500000 6187.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 32 63.500000 4762.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 43 85.500000 6412.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 52 103.000000 5716.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 23.500000 1762.5000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 8 33.000000 1650.0000 50.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH 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
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) 134 415.500000 28074.7500 67.5686
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 66.5000 66.5000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 65 111.500000 5562.5000 49.8879
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 38 62.500000 3125.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 98 134.500000 3362.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 12 13.000000 650.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 10 16.750000 837.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 5.500000 137.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 27.000000 1350.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 3 3.000000 150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 6.000000 300.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 3 3.000000 150.0000 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 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 196 1135.000000 56750.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 78 398.000000 19900.0000 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 61 324.500000 23182.2800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 5 17.750000 1268.0600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 40 224.000000 16002.5600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 5 16.000000 1143.0400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 174 1159.500000 82834.6800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 33 143.000000 10215.9200 71.4400
TRAV-TRAVS-Travel by mile 531 50186.00000 22070.2700 0.4398
Subtotal (Total Children Is Unduplicated) 866 54309.75000 257475.8100 4.7409
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Total 62522.250000 573836.0600 9.1781
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Number of Children (Unduplicated) With at Least One Service 1854
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Center 09
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 7762 42961.000000 396600.1500 396600.1500
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 3753 19520.000000 175075.6600 175084.9100
30 25.250000 960.2500 0.0000
Other 8 16.000000 1200.0000 0.0000
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Total 11553 62522.250000 573836.0600 571685.0600