CMS/EIP Fiscal Report Center: 54
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 Page: 1
List order: No List
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 778 654.250000 24198.0000 36.9859
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 43 38.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 647 1661.250000 61466.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1104 2354.000000 85664.2500 36.3909
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 7.000000 339.5000 48.5000
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 9 18.000000 1350.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 12 23.000000 1725.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 10 20.000000 1500.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 25 49.500000 2747.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 44.000000 3300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 55 169.500000 11444.7500 67.5206
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 22.000000 1040.0500 47.2750
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 52 45.000000 2250.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 154 172.750000 8637.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 41 26.250000 1300.0000 49.5238
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 273 191.500000 9575.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 10 9.000000 450.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 287 154.750000 7737.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 0.750000 18.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 19 14.750000 737.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 272 138.250000 6912.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 5.000000 250.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 288 155.250000 7762.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 127 274.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 27.500000 1375.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 64 324.250000 16212.5000 50.0000
INTR-T1013-INTERPRETER 8 42.750000 1693.7500 39.6199
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 167 473.000000 4730.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 7.500000 535.8000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 9 18.000000 1285.9200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 8 18.000000 1285.9200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 12 34.000000 2428.9600 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 1 2.000000 142.8800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 4 7.750000 553.6600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 41.000000 2929.0400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 22 96.750000 6911.8200 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 5.000000 357.2000 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 76 97.500000 3607.5000 37.0000
TRAV-TRAVS-Travel by mile 52 3967.000000 1765.1200 0.4450
Subtotal (Total Children Is Unduplicated) 630 6372.500000 92557.8100 14.5246
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Total 8896.000000 189666.8100 21.3205
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Number of Children (Unduplicated) With at Least One Service 1226
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Center 54
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 1 1.750000 64.7500 64.7500
D 18 17.750000 1225.1800 0.0000
S 14 9.500000 325.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 454 2037.250000 16864.9500 16864.9500
6728 6782.750000 169447.6800 0.0000
Other 77 47.000000 1739.0000 0.0000
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Total 7292 8896.000000 189666.8100 16929.7000