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
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 909 976.750000 36139.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 29 20.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 267 847.500000 31357.5000 37.0000
Subtotal (Total Children Is Unduplicated) 941 1844.750000 67497.2500 36.5888
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 10 12.000000 600.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 25 41.000000 2050.0000 50.0000
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 11 19.906133 1492.9600 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 49 76.906133 4392.9500 57.1209
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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 12 73.000000 3650.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 5.000000 250.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 8.000000 571.5200 71.4400
Subtotal (Total Children Is Unduplicated) 27 122.500000 5884.0200 48.0328
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Total 2044.156133 77774.2200 38.0471
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Number of Children (Unduplicated) With at Least One Service 945
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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 0 0.000000 0.0000 0.0000
P 2 1.750000 64.7500 64.7500
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 0 0.000000 0.0000 0.0000
3880 2042.406133 77709.4700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3882 2044.156133 77774.2200 64.7500