CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 2 14.000000 518.0000 37.0000
Subtotal (Total Children Is Unduplicated) 2 14.000000 518.0000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 15.500000 810.2500 52.2742
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 19 35.500000 2512.5000 70.7746
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 19 37.000000 2735.0000 73.9189
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 75 145.000000 7774.4500 53.6169
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 31.0500 31.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 133.1500 44.3833
Subtotal (Total Children Is Unduplicated) 97 240.500000 14258.9000 59.2886
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EI Services,Class #03
OCCT-97530GT-OT SESSION BY LICENSED OT 2 6.000000 388.6400 64.7733
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 6.750000 482.2200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 9.000000 642.9600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 25.000000 1498.4400 59.9376
Subtotal (Total Children Is Unduplicated) 9 46.750000 3012.2600 64.4334
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Total 301.250000 17789.1600 59.0512
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Number of Children (Unduplicated) With at Least One Service 104
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Center 09
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 68 112.000000 5936.0800 6199.5600
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 3 6.000000 333.0000 0.0000
116 183.250000 11520.0800 225.0000
Other 0 0.000000 0.0000 0.0000
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Total 187 301.250000 17789.1600 6424.5600