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
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 1846 6087.750000 225164.7500 36.9865
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 2.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 705 2778.750000 102749.0000 36.9767
Subtotal (Total Children Is Unduplicated) 1904 8868.750000 327913.7500 36.9741
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 127 206.000000 10300.0000 50.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 15 28.500000 2137.5000 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 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 27 54.000000 2997.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 171 321.000000 17794.0000 55.4330
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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 2 2.000000 100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 19 105.000000 5250.0000 50.0000
INTR-T1013-INTERPRETER 95 361.750000 18087.5000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 1 3.750000 267.9000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 20.250000 1446.6600 71.4400
Subtotal (Total Children Is Unduplicated) 157 570.250000 28542.2500 50.0522
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Total 9760.000000 374250.0000 38.3453
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Number of Children (Unduplicated) With at Least One Service 1931
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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 0 0.000000 0.0000 0.0000
P 10267 9711.250000 372335.2500 372335.2500
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 56 42.750000 1581.7500 1581.7500
0 0.000000 0.0000 0.0000
Other 3 6.000000 333.0000 0.0000
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Total 10326 9760.000000 374250.0000 373917.0000