CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2021 ending 09/30/2021 Date of Report:10/13/2021 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 973 1485.000000 54824.7500 36.9190
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 28 38.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 303 776.750000 28739.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1076 2300.000000 83564.5000 36.3324
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
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
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 13.000000 975.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 11 20.500000 1537.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.500000 337.5000 75.0000
Subtotal (Total Children Is Unduplicated) 27 66.000000 4692.5000 71.0985
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 2.000000 100.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 25 18.500000 925.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 0.500000 25.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 148 116.000000 5800.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 11.750000 587.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 184 132.000000 6600.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 7 4.500000 112.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 6.250000 312.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 121 59.750000 2987.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 12.750000 637.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 149 97.750000 4887.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 97 198.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 7.750000 387.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 110 285.000000 2800.0000 9.8246
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 5 10.750000 767.9800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 285.7600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 25.000000 1786.0000 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 51 49.750000 1840.7500 37.0000
Subtotal (Total Children Is Unduplicated) 380 1047.750000 31117.1200 29.6990
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Total 3413.750000 119374.1200 34.9686
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Number of Children (Unduplicated) With at Least One Service 1146
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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 1 0.500000 18.5000 0.0000
D 6 5.250000 194.2500 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
5660 3408.000000 119161.3700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5667 3413.750000 119374.1200 0.0000