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
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
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 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 6 12.000000 900.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 20 39.500000 2962.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 44 87.000000 4828.5000 55.5000
OCTH-97166GT-OT EVAL MODERATE 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-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 56 149.500000 9398.6500 62.8672
-----------------------------------------------------------------------------------------------------------------------
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 1 1.000000 50.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 64.000000 3200.0000 50.0000
INTR-T1013-INTERPRETER 49 94.750000 4737.5000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 2 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 7 28.000000 2000.3200 71.4400
Subtotal (Total Children Is Unduplicated) 104 262.500000 13328.1100 50.7738
-----------------------------------------------------------------------------------------------------------------------
Total 8209.000000 311012.2600 37.8867
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1780
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 5961 5478.250000 208128.9900 208128.9900
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 3017 2707.500000 102023.0200 102032.2700
29 23.250000 860.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9007 8209.000000 311012.2600 310161.2600