CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2021 ending 03/31/2021 Date of Report:05/04/2021 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 993 1710.500000 63205.5000 36.9515
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 13.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1243 3209.750000 118696.0000 36.9798
Subtotal (Total Children Is Unduplicated) 1327 4934.000000 181901.5000 36.8669
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 22 43.000000 2150.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 18.000000 1350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 15.000000 832.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 87 166.000000 12450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 22.000000 1650.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 70 132.500000 9937.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 44 81.500000 6112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 146 274.500000 15234.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 59 111.000000 8325.0000 75.0000
Subtotal (Total Children Is Unduplicated) 234 910.000000 61322.5000 67.3874
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 2.750000 137.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 21 14.500000 725.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 15 6.250000 312.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 216 247.250000 12338.0000 49.9009
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 5.750000 287.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 168 127.000000 6350.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 4.000000 200.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 125 63.000000 3150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 21 15.750000 762.5000 48.4127
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 127 108.750000 5437.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 12 26.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 18.500000 925.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 225 1054.250000 52712.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8 12.000000 120.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 7.000000 500.0800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 36 171.500000 12230.5200 71.3150
OCCT-97530TLGT-OT SESSION BY LICENSED OT 29 118.000000 8429.9200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 7.750000 553.6600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 12 90.250000 6447.4600 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 22 126.750000 9055.0200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 6.000000 428.6400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 40 142.250000 10162.3400 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 40 214.000000 15266.7200 71.3398
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 33 50.500000 1868.5000 37.0000
TRAV-TRAVS-Travel by mile 2 3.000000 1.3200 0.4400
Subtotal (Total Children Is Unduplicated) 513 2645.500000 148511.1200 56.1373
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Total 8489.500000 391735.1200 46.1435
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Number of Children (Unduplicated) With at Least One Service 1362
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Center 53
Flag Claims Units Chgs Paid
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R 49 49.250000 1960.0100 0.0000
U 0 0.000000 0.0000 0.0000
B 2648 2398.750000 115675.9900 0.0000
P 2111 1860.250000 88710.3500 88710.3500
D 253 197.500000 10146.8600 0.0000
S 87 65.000000 2880.7600 0.0000
H 0 0.000000 0.0000 0.0000
T 2 1.500000 75.0000 0.0000
6397 3877.750000 169895.9200 0.0000
Other 42 39.500000 2390.2300 92.5000
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Total 11589 8489.500000 391735.1200 88802.8500