CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2020 ending 06/30/2021 Date of Report:07/15/2021 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 2322 6448.500000 238383.2500 36.9672
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 63 77.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2818 13109.75000 484608.5000 36.9655
Subtotal (Total Children Is Unduplicated) 2864 19635.50000 722991.7500 36.8206
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 6 11.000000 550.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 44 84.500000 4225.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 26 49.000000 3675.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.500000 337.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 21 41.000000 3075.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 11 22.000000 1650.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 13 26.000000 1950.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 31 57.000000 3108.0000 54.5263
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 46.500000 3487.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 323 613.500000 46012.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 39 67.500000 5062.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 250 470.500000 35587.5000 75.6376
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 151 277.000000 20775.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 511 963.500000 53609.7500 55.6406
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 270 504.000000 37800.0000 75.0000
SCREEN-T1023-SCREENING 2 4.000000 200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 899 3281.500000 223691.5000 68.1675
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 8.500000 425.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 74 60.750000 3037.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 56 26.250000 1312.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 625 969.000000 48389.5000 49.9376
CONIP-CONIP-CONSULT, ITDS PHONE 3 4.000000 93.7500 23.4375
CONOF-CONOF-CONSULT, OT, FACE TO FACE 43 27.750000 1387.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 521 554.500000 26500.0000 47.7908
CONOP-CONOP-CONSULT, OT, PHONE 11 8.750000 218.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 44 26.000000 1300.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 383 259.000000 12950.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 75 58.500000 2900.0000 49.5726
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 479 526.500000 26312.5000 49.9763
CONSP-CONSP-CONSULT, SLP, PHONE 11 8.000000 200.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 68 168.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 8.500000 212.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 55 87.250000 4362.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 421 3943.250000 197162.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 70 174.000000 1740.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 24 42.000000 3000.4800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 59 504.000000 36604.2400 72.6275
OCCT-97530TL-OT SESSION BY LICENSED OT 2 3.000000 214.3200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 75 633.750000 45275.1000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 13 44.750000 3277.5000 73.2402
PHY-97110GT-PT SESSION BY LICENSED PT 27 345.500000 26798.2800 77.5638
PHY-97110TL-PT SESSION BY LICENSED PT 3 9.000000 642.9600 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 53 533.250000 38095.3800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 46.000000 3286.2400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 81 618.250000 44149.4100 71.4103
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 9 25.000000 1786.0000 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 103 898.500000 64109.8400 71.3521
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.8800 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 122 198.500000 7344.5000 37.0000
TRAV-TRAVS-Travel by mile 1 1.000000 0.4400 0.4400
Subtotal (Total Children Is Unduplicated) 1046 10822.25000 603103.0700 55.7281
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Total 33739.250000 1549786.3200 45.9342
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Number of Children (Unduplicated) With at Least One Service 2874
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Center 53
Flag Claims Units Chgs Paid
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R 2403 2192.000000 104927.8400 0.0000
U 0 0.000000 0.0000 0.0000
B 3292 2931.750000 141652.9600 59.2500
P 13622 12161.410000 582114.6800 579707.0200
D 601 547.590000 32778.4300 0.0000
S 256 234.750000 13808.2700 0.0000
H 28 28.000000 1964.6000 0.0000
T 8 5.500000 245.7500 0.0000
25350 15033.000000 632599.1300 83.2500
Other 571 605.250000 39694.6600 229.2500
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Total 46131 33739.250000 1549786.3200 580078.7700