CMS/EIP Fiscal Report Center: 52
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 450 283.750000 10452.7500 36.8379
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 16 4.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 724 2372.250000 87443.2500 36.8609
Subtotal (Total Children Is Unduplicated) 770 2660.000000 97896.0000 36.8030
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 555.0000 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 133 268.500000 19457.5000 72.4674
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 16 34.000000 2380.0000 70.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 50.000000 2775.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 79 157.000000 8713.5000 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 15 15.000000 750.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 7.000000 357.3500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 178 581.500000 37771.1000 64.9546
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 15 12.500000 625.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 17 16.500000 825.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 8.500000 212.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 17 23.000000 1150.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 4 3.750000 175.0000 46.6667
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 13.250000 662.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 1.500000 75.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 25 33.000000 1650.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 6 4.750000 237.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 57 72.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 114 557.250000 27802.5000 49.8923
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 13 36.500000 1725.0000 47.2603
INTR-T1013-INTERPRETER 3 29.000000 1450.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 147 720.000000 7182.0000 9.9750
OCCT-97530-OT SESSION BY LICENSED OT 2 4.000000 285.7600 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 1 3.000000 214.3200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 226.750000 15034.1800 66.3029
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 10 29.750000 2022.4600 67.9818
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 21 90.500000 6465.3200 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 15.250000 1089.4600 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 0.750000 27.7500 37.0000
TRAV-TRAVS-Travel by mile 166 9772.000000 4347.9900 0.4449
Subtotal (Total Children Is Unduplicated) 259 11678.25000 73468.1800 6.2910
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Total 14919.750000 209135.2800 14.0173
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Number of Children (Unduplicated) With at Least One Service 781
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Center 52
Flag Claims Units Chgs Paid
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R 6 6.250000 307.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 429 449.750000 23363.8700 0.0000
P 1536 1597.750000 70916.3400 70246.8600
D 99 124.000000 6613.3200 0.0000
S 429 422.000000 17246.7100 155.0500
H 92 108.000000 6963.2300 40.0000
T 1103 10890.000000 36111.7800 29010.1100
2051 1322.000000 47612.7800 11.5700
Other 0 0.000000 0.0000 0.0000
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Total 5745 14919.750000 209135.2800 99463.5900