CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 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 1846 6087.750000 225164.7500 36.9865
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 2.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1781 6904.750000 255411.0000 36.9906
Subtotal (Total Children Is Unduplicated) 1992 12994.75000 480575.7500 36.9823
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 127 206.000000 10300.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 14 25.000000 1337.5000 53.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 101 180.000000 13315.0000 73.9722
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 86 152.000000 11245.6900 73.9848
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 215 404.000000 22097.0000 54.6955
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 433 998.000000 60488.6400 60.6099
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.250000 62.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 26 45.000000 2250.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 18 19.250000 481.2500 25.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 4 4.000000 200.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 2 3.000000 150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 6.000000 300.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 46 230.000000 11500.0000 50.0000
INTR-T1013-INTERPRETER 95 361.750000 18087.5000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 3 6.750000 482.2200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 3 16.750000 1196.6200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 5.000000 357.2000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 38.250000 2532.5800 66.2112
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 16.000000 1071.6400 66.9775
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 182 759.000000 38931.8300 51.2936
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Total 14751.750000 579996.2200 39.3171
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Number of Children (Unduplicated) With at Least One Service 2013
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Center 09
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 368 401.000000 16178.5700 166.5000
P 14084 13694.000000 530700.0700 531271.8820
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 183 304.500000 17295.7500 0.0000
T 62 50.250000 1892.5000 2109.0000
282 283.750000 13106.0800 0.0000
Other 12 18.250000 823.2500 0.0000
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Total 14991 14751.750000 579996.2200 533547.3820