CMS/EIP Fiscal Report Center: 51
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
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 20.500000 1462.5000 71.3415
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 58 62.500000 3468.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 10.500000 787.5000 75.0000
Subtotal (Total Children Is Unduplicated) 72 97.000000 5913.0000 60.9588
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 51.000000 2550.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 14 108.000000 7715.5200 71.4400
Subtotal (Total Children Is Unduplicated) 29 161.000000 10365.5200 64.3821
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Total 258.000000 16278.5200 63.0950
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Number of Children (Unduplicated) With at Least One Service 98
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Center 51
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 23 30.000000 2045.2500 0.0000
P 0 0.000000 0.0000 0.0000
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
131 228.000000 14233.2700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 154 258.000000 16278.5200 0.0000