CMS/EIP Fiscal Report Center: 53
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 966 1486.000000 54982.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17 14.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 341 657.750000 24336.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1063 2157.750000 79318.7500 36.7599
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 4 8.000000 400.0000 50.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 14.500000 1087.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 20.000000 1110.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 24 59.000000 3808.5000 64.5508
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 2.250000 112.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 17 13.250000 662.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 2.500000 62.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 9 3.500000 175.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 142 129.000000 6450.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 16 4.750000 118.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 5.750000 287.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 100 75.500000 3775.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 10 3.750000 93.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 30 42.000000 2100.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 147 78.750000 3937.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 8 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 12.750000 637.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 137 73.000000 3650.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 4.500000 112.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 163 505.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 5.000000 250.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 6 23.750000 1187.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 152 507.000000 5070.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 23.000000 1643.1200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 9 16.000000 1143.0400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 7.000000 500.0800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 3.750000 267.9000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 11.000000 785.8400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 22.000000 1571.6800 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 45 46.250000 1711.2500 37.0000
Subtotal (Total Children Is Unduplicated) 373 1623.250000 36355.4100 22.3967
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Total 3840.000000 119482.6600 31.1153
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Number of Children (Unduplicated) With at Least One Service 1124
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Center 53
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 0 0.000000 0.0000 0.0000
D 15 18.000000 779.0000 0.0000
S 18 13.750000 618.9400 92.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6308 3790.000000 117409.4700 0.0000
Other 24 18.250000 675.2500 0.0000
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Total 6365 3840.000000 119482.6600 92.5000