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
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 450 283.750000 10452.7500 36.8379
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 16 4.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 304 980.750000 36130.5000 36.8397
Subtotal (Total Children Is Unduplicated) 591 1268.500000 46583.2500 36.7231
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 355.0000 59.1667
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 11 25.000000 1443.0000 57.7200
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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 4.250000 212.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 57 72.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 11.000000 550.0000 50.0000
INTR-T1013-INTERPRETER 3 29.000000 1450.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 147 720.000000 7182.0000 9.9750
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 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) 241 10726.75000 19425.6200 1.8110
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Total 12020.250000 67451.8700 5.6115
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Number of Children (Unduplicated) With at Least One Service 651
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Center 52
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 1 2.000000 111.0000 52.2800
D 9 12.500000 662.5000 0.0000
S 156 140.250000 5115.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 857 10619.000000 19105.0500 17715.1700
1990 1246.500000 42458.0700 11.5700
Other 0 0.000000 0.0000 0.0000
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Total 3013 12020.250000 67451.8700 17779.0200