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
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 2322 6448.000000 238364.7500 36.9672
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 63 77.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 873 3185.250000 117679.2500 36.9451
Subtotal (Total Children Is Unduplicated) 2522 9710.500000 356044.0000 36.6659
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 6 11.000000 550.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 43 82.500000 4125.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
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 18 33.000000 2475.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 19 32.500000 2437.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 10 18.500000 1387.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 39 76.000000 4218.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 33.500000 2512.5000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 122 304.500000 18885.7500 62.0222
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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 521 552.500000 26400.0000 47.7828
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 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 4.000000 200.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 25 83.000000 4150.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 70 174.000000 1740.0000 10.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 13 33.250000 2375.3800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 3 8.000000 571.5200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 2 6.000000 428.6400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 6 17.750000 1268.0600 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 15 65.500000 4679.3200 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
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) 831 3298.750000 147924.1800 44.8425
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Total 13313.750000 522853.9300 39.2717
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Number of Children (Unduplicated) With at Least One Service 2552
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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 3 0.750000 34.2500 0.0000
P 2 1.000000 37.0000 18.5000
D 142 100.000000 4327.8200 0.0000
S 24 12.250000 576.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 7 3.500000 171.7500 0.0000
23755 13196.250000 517706.3600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 23933 13313.750000 522853.9300 18.5000