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
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 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
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 12.000000 900.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 17.000000 1275.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 21 40.000000 2220.0000 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 87 159.000000 11750.0000 73.8994
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 81 156.000000 11655.0000 74.7115
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 244 464.000000 25123.7900 54.1461
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
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-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 332 865.000000 54024.6400 62.4562
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.500000 125.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 18 29.500000 1475.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 19 24.250000 606.2500 25.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 4 4.750000 237.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 3 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 35 146.000000 7300.0000 50.0000
INTR-T1013-INTERPRETER 49 94.750000 4737.5000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 4 23.750000 1696.7000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 6 40.500000 2893.3200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 8.750000 625.1000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 10 47.000000 3241.6400 68.9711
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 5 27.000000 1928.8800 71.4400
Subtotal (Total Children Is Unduplicated) 134 455.750000 25238.3300 55.3776
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Total 12754.500000 501969.4700 39.3563
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Number of Children (Unduplicated) With at Least One Service 1878
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Center 09
Flag Claims Units Chgs Paid
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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 8792 8580.000000 335776.0100 336187.8700
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 3059 2784.000000 106384.6800 105739.9300
243 255.000000 11453.5300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13052 12754.500000 501969.4700 441927.8000