CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 Page: 1
List order: No List
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 1022 608.500000 22505.5000 36.9852
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 4.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1940 4721.000000 174632.0000 36.9905
Subtotal (Total Children Is Unduplicated) 2015 5333.500000 197137.5000 36.9621
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 8 16.000000 800.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 7.500000 523.5000 69.8000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.500000 444.7500 46.8158
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 14.500000 1087.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 276 480.000000 35818.8100 74.6225
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 79 142.500000 10650.0000 74.7368
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 88 157.000000 11775.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 17.000000 943.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 258 456.000000 25262.2500 55.3997
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 379 1320.500000 88725.8100 67.1911
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 2 2.000000 100.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 55 51.000000 2425.0000 47.5490
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 16 15.500000 775.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 58 46.000000 1150.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 6 7.250000 337.5000 46.5517
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 5.500000 275.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 17 15.750000 381.2500 24.2063
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 6.750000 337.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 3 5.500000 275.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 2.750000 68.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.500000 25.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 0.500000 25.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 14 13.500000 325.0000 24.0741
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1020 7201.250000 359962.5000 49.9861
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 205 704.000000 35100.0000 49.8580
INTR-T1013-INTERPRETER 8 70.000000 5600.0000 80.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1145 8564.000000 85460.0000 9.9790
OCCT-97530-OT SESSION BY LICENSED OT 29 133.250000 9342.5100 70.1126
OCCT-97530GT-OT SESSION BY LICENSED OT 12 24.000000 1613.8900 67.2454
OCCT-97530HM-OT SESSION BY OT ASST 20 99.000000 4570.1800 46.1634
OCCT-97530HMGT-OT SESSION BY OT ASST 5 15.000000 858.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 44 174.750000 12319.2100 70.4962
PHY-97110GT-PT SESSION BY LICENSED PT 13 34.000000 2428.9600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 18 58.500000 3343.8600 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 4 6.000000 342.9600 57.1600
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 119 492.250000 33946.4900 68.9619
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 53 193.750000 13781.5000 71.1303
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 0.500000 18.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1299 17946.75000 575331.5600 32.0577
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Total 24600.750000 861194.8700 35.0069
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Number of Children (Unduplicated) With at Least One Service 2207
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Center 06
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 8197 7950.000000 166805.1700 166805.1700
D 0 0.000000 0.0000 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
19896 16508.750000 689135.7000 0.0000
Other 193 142.000000 5254.0000 0.0000
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Total 28286 24600.750000 861194.8700 166805.1700