CMS/EIP Fiscal Report Center: 52
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 392 185.750000 6863.5000 36.9502
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 55 25.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 772 2394.750000 88476.2500 36.9459
Subtotal (Total Children Is Unduplicated) 858 2606.000000 95339.7500 36.5847
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 120 247.500000 17580.0000 71.0303
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 19 37.500000 2812.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 51 108.000000 7635.0000 70.6944
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 38.000000 2680.0000 70.5263
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 116 234.000000 12855.0000 54.9359
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 19.500000 1082.2500 55.5000
SCREEN-T1023-SCREENING 24 24.000000 1200.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 174 747.500000 48531.9500 64.9257
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 27 29.750000 1487.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 20 20.500000 1025.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 8.500000 212.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 39 49.750000 2487.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 3.250000 162.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.750000 18.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 10.000000 500.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 31 34.250000 1712.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 0.750000 37.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 142 226.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 168 921.500000 46050.0000 49.9729
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 4.500000 225.0000 50.0000
INTR-T1013-INTERPRETER 5 12.000000 600.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 162 781.000000 7810.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 4.000000 80.0000 20.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 214.750000 12641.6300 58.8667
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 21.250000 1518.1000 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 24 103.750000 7411.9000 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
TRAV-TRAVS-Travel by mile 218 15116.00000 6725.8700 0.4450
Subtotal (Total Children Is Unduplicated) 335 17568.00000 90990.1900 5.1793
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Total 20921.500000 234861.8900 11.2259
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Number of Children (Unduplicated) With at Least One Service 899
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Center 52
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 601 616.250000 27850.7200 252.1000
P 1879 2044.750000 96888.6600 99422.4700
D 204 221.750000 11246.2500 130.0000
S 19 23.250000 1125.3200 231.7500
H 161 205.000000 13001.3200 35.0000
T 1296 16370.500000 40157.1100 33937.0200
2251 1428.750000 44176.2600 0.0000
Other 18 11.250000 416.2500 0.0000
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Total 6429 20921.500000 234861.8900 134008.3400