CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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 331 151.750000 5605.5000 36.9390
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 52 32.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 255 820.250000 30293.7500 36.9323
Subtotal (Total Children Is Unduplicated) 488 1004.500000 35899.2500 35.7384
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 4 17.000000 1134.0500 66.7088
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 42 44.500000 2225.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 68 71.500000 3550.0000 49.6503
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 28 21.500000 537.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 63 80.500000 4025.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 7 7.500000 375.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 40 69.000000 3450.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 4 3.000000 150.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 22 50.750000 2537.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 46 48.750000 2437.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 3 2.500000 125.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.250000 6.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 115 195.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 35.000000 1627.6000 46.5029
INTR-T1013-INTERPRETER 1 8.000000 400.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 551 3120.000000 31200.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 0.500000 35.7200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 6.000000 342.9600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 12.500000 893.0000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 285.7600 71.4400
TRAV-TRAVS-Travel by mile 456 30234.00000 13452.0800 0.4449
Subtotal (Total Children Is Unduplicated) 674 34024.75000 68048.7500 2.0000
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Total 35046.250000 105082.0500 2.9984
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Number of Children (Unduplicated) With at Least One Service 815
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Center 52
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 2 4.000000 222.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3170 33617.000000 67171.7000 66026.2900
1976 1425.250000 37688.3500 114.1000
Other 0 0.000000 0.0000 0.0000
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Total 5148 35046.250000 105082.0500 66140.3900