CMS/EIP Fiscal Report Center: 55
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 923 955.750000 35362.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 51 39.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 381 986.000000 36482.0000 37.0000
Subtotal (Total Children Is Unduplicated) 997 1981.500000 71844.7500 36.2578
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 6 10.000000 500.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 21 32.000000 1600.0000 50.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 16.000000 1200.0000 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 5 10.000000 555.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 47 82.000000 4738.0000 57.7805
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 7 7.000000 350.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 7.000000 350.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 8 7.000000 175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 79.000000 3950.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 27 107.000000 5075.0000 47.4299
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Total 2170.500000 81657.7500 37.6216
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Number of Children (Unduplicated) With at Least One Service 1003
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Center 55
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3776 2170.500000 81657.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3776 2170.500000 81657.7500 0.0000