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
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 331 151.750000 5605.5000 36.9390
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 52 32.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 675 2084.250000 76812.0000 36.8535
Subtotal (Total Children Is Unduplicated) 728 2268.500000 82417.5000 36.3313
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 108 216.500000 16005.6500 73.9291
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 44 92.000000 6560.0000 71.3043
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 18 36.000000 2700.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 20 40.000000 3000.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 10.000000 408.2000 40.8200
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 82 163.000000 9046.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
SCREEN-T1023-SCREENING 15 16.000000 750.0000 46.8750
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 159 607.000000 40644.1500 66.9591
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 28 27.750000 1387.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 22 21.250000 1062.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 6.250000 156.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 31 35.000000 1750.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 2 2.500000 125.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 13.000000 650.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 35 34.250000 1712.5000 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-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 168 959.000000 47785.0000 49.8279
INTR-T1013-INTERPRETER 1 8.000000 400.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 149 791.000000 7910.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 7.000000 500.0800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 142.8800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 181.500000 11190.9600 61.6582
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 7.750000 553.6600 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 22 97.750000 6983.2600 71.4400
TRAV-TRAVS-Travel by mile 212 13654.00000 6075.2900 0.4449
Subtotal (Total Children Is Unduplicated) 323 16049.75000 88716.1300 5.5276
-----------------------------------------------------------------------------------------------------------------------
Total 18925.250000 211777.7800 11.1902
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 785
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 42 43.000000 2416.5200 0.0000
U 0 0.000000 0.0000 0.0000
B 563 615.000000 30038.0800 37.0000
P 1590 1664.250000 75238.6800 73914.3900
D 171 189.250000 9710.5000 0.0000
S 29 35.250000 1540.1300 59.2500
H 90 112.750000 6981.7500 9.2500
T 1195 14799.250000 34506.1200 29131.1100
2130 1463.750000 51244.2500 1306.2300
Other 4 2.750000 101.7500 0.0000
---------------------------------------------------------
Total 5814 18925.250000 211777.7800 104457.2300