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
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 778 654.250000 24198.0000 36.9859
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 43 38.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1407 4608.750000 170514.5000 36.9980
Subtotal (Total Children Is Unduplicated) 1451 5301.500000 194712.5000 36.7278
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 6 6.000000 291.0000 48.5000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 65 127.000000 9525.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 62 116.000000 8700.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 45 87.500000 6562.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 42 84.000000 4662.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 11.500000 862.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 69 137.500000 10312.5000 75.0000
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 222 614.000000 44166.1000 71.9318
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 23 20.750000 1037.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 127 135.000000 6750.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 31 10.250000 500.0000 48.7805
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 263 168.000000 8400.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 2.750000 137.5000 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 271 137.250000 6862.5000 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 127 276.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 7.000000 350.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 122 458.000000 22900.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 123 318.000000 3180.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 45.500000 3250.5200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 39 103.000000 7394.0400 71.7868
OCCT-97530TL-OT SESSION BY LICENSED OT 9 21.500000 1535.9600 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 46 133.500000 9537.2400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 22 51.000000 3643.4400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 25 86.250000 6161.7000 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 18 74.000000 5286.5600 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 32 103.750000 7411.9000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 86.500000 6179.5600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 51 230.250000 16449.0600 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 9 19.000000 1357.3600 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 41 197.250000 14091.5400 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 48 56.500000 2090.5000 37.0000
Subtotal (Total Children Is Unduplicated) 630 3072.000000 151013.1300 49.1579
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Total 8987.500000 389891.7300 43.3816
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Number of Children (Unduplicated) With at Least One Service 1461
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Center 54
Flag Claims Units Chgs Paid
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R 3 4.250000 157.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3179 2678.000000 123228.4500 1959.2500
P 1645 1439.500000 66853.5600 66734.5900
D 32 31.500000 2035.9600 0.0000
S 24 18.000000 687.1900 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6763 4624.750000 187636.1000 0.0000
Other 252 191.500000 9293.2200 0.0000
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Total 11898 8987.500000 389891.7300 68693.8400