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
Payclass Filters:TPIN
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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 12 24.000000 1800.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 13 24.000000 1800.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 17.500000 1312.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 20.000000 1500.0000 75.0000
Subtotal (Total Children Is Unduplicated) 32 89.500000 6712.5000 75.0000
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2 2.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 10 50.250000 2512.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 33.000000 2357.5200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 27 78.000000 5608.0400 71.8979
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 10 12.000000 857.2800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 14 53.750000 3839.9000 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 20.000000 1428.8000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 27 128.500000 9180.0400 71.4400
Subtotal (Total Children Is Unduplicated) 87 381.750000 26048.4000 68.2342
-----------------------------------------------------------------------------------------------------------------------
Total 471.250000 32760.9000 69.5192
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 107
-----------------------------------------------------------------------------------------------------------------------
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
S 2 2.000000 121.4400 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
391 427.250000 29824.8200 0.0000
Other 41 42.000000 2814.6400 0.0000
---------------------------------------------------------
Total 434 471.250000 32760.9000 0.0000