CMS/EIP Fiscal Report Center: 53
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 927 1405.750000 51930.5000 36.9415
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 21 17.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1126 3192.000000 117900.5000 36.9362
Subtotal (Total Children Is Unduplicated) 1231 4615.000000 169831.0000 36.7998
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Screening, Eval, and Assessment,Class #02
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 12.000000 610.5000 50.8750
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 76 149.500000 11212.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 21.500000 1612.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 59 112.000000 8400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 45 83.500000 6262.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 114 221.000000 12265.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 70 127.000000 9525.0000 75.0000
Subtotal (Total Children Is Unduplicated) 226 754.000000 51862.0000 68.7825
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.000000 100.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 23 20.000000 1000.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 12 5.000000 250.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 202 226.000000 11264.0000 49.8407
CONIP-CONIP-CONSULT, ITDS PHONE 2 0.750000 18.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 3.750000 187.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 133 129.000000 5250.0000 40.6977
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 6.000000 300.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 114 56.500000 2825.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 22 14.750000 737.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 106 79.250000 3962.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 5 7.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 15.000000 750.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 201 917.500000 45875.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 2.000000 20.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 29 111.750000 7983.4200 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 36 172.500000 12323.4000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 2.000000 142.8800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 16 103.500000 7394.0400 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 21 115.250000 8233.4600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 36 156.750000 11176.7800 71.3032
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 38 169.250000 12091.2200 71.4400
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.8800 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 35 43.750000 1618.7500 37.0000
Subtotal (Total Children Is Unduplicated) 479 2366.250000 133748.4600 56.5234
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Total 7735.250000 355441.4600 45.9509
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Number of Children (Unduplicated) With at Least One Service 1268
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Center 53
Flag Claims Units Chgs Paid
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R 11 11.750000 469.1900 0.0000
U 0 0.000000 0.0000 0.0000
B 3197 2848.250000 135143.0400 0.0000
P 1255 1208.000000 56348.6400 56038.8900
D 73 67.750000 3716.1700 0.0000
S 14 9.500000 475.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 50 40.000000 1975.5000 0.0000
5720 3509.000000 154655.1600 0.0000
Other 45 41.000000 2658.7600 37.0000
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Total 10365 7735.250000 355441.4600 56075.8900