CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2021 ending 06/30/2021 Date of Report:07/15/2021 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 1010 1572.500000 58145.7500 36.9766
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 24 34.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 352 838.500000 30987.5000 36.9559
Subtotal (Total Children Is Unduplicated) 1148 2445.000000 89133.2500 36.4553
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 4 7.000000 350.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 20 37.500000 1875.0000 50.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
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 6 10.500000 787.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 15.500000 1162.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.000000 832.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 40 94.500000 5643.5000 59.7196
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 3.250000 162.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 22 17.500000 875.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 6 3.000000 150.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 210 224.500000 11225.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 11.500000 575.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 193 151.750000 7562.5000 49.8353
CONOP-CONOP-CONSULT, OT, PHONE 10 7.750000 193.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 3.750000 187.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 116 68.000000 3400.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 28 20.000000 1000.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 185 129.000000 6450.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 3.000000 75.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 59 126.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 9 17.000000 850.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 67 158.000000 1580.0000 10.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 4 3.750000 267.9000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 2 6.000000 428.6400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 3 9.000000 642.9600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 14.000000 1000.1600 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 40 34.250000 1267.2500 37.0000
TRAV-TRAVS-Travel by mile 1 1.000000 0.4400 0.4400
Subtotal (Total Children Is Unduplicated) 360 1016.000000 38111.4800 37.5113
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Total 3555.500000 132888.2300 37.3754
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Number of Children (Unduplicated) With at Least One Service 1207
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Center 53
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 0 0.000000 0.0000 0.0000
D 6 5.250000 231.2500 0.0000
S 2 2.750000 101.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6279 3547.500000 132555.2300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6287 3555.500000 132888.2300 0.0000