CMS/EIP Fiscal Report Center: 55
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 909 976.750000 36139.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 29 20.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 942 3080.250000 113947.0500 36.9928
Subtotal (Total Children Is Unduplicated) 1012 4077.500000 150086.8000 36.8085
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 11 14.000000 700.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 26 43.000000 2150.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 143 288.000000 21600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 199 376.000000 26488.2400 70.4474
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EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 11 10.250000 512.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 9 8.000000 200.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 8.750000 437.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 10 8.500000 212.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 29 170.000000 8500.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 9 28.000000 1400.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 29.500000 2107.4800 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 18 135.500000 9680.1200 71.4400
Subtotal (Total Children Is Unduplicated) 55 399.500000 23100.1000 57.8225
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Total 4853.000000 199675.1400 41.1447
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Number of Children (Unduplicated) With at Least One Service 1014
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Center 55
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 2974 2390.500000 101758.3200 0.0000
P 415 313.500000 12641.3000 15808.3500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 33 54.500000 3979.7300 0.0000
T 0 0.000000 0.0000 0.0000
3923 2094.500000 81295.7900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7345 4853.000000 199675.1400 15808.3500