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
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 2 4.000000 222.0000 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 15.000000 1023.0500 68.2033
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 27 26.750000 1337.5000 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
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-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 11.000000 550.0000 50.0000
INTR-T1013-INTERPRETER 1 8.000000 400.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 149 791.000000 7910.0000 10.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 6.500000 464.3600 71.4400
TRAV-TRAVS-Travel by mile 212 13654.00000 6075.2900 0.4449
Subtotal (Total Children Is Unduplicated) 320 14808.25000 22374.6500 1.5110
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Total 15827.750000 59296.9500 3.7464
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Number of Children (Unduplicated) With at Least One Service 640
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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 991 14573.500000 21464.4700 20319.0600
1974 1250.250000 37610.4800 36.2300
Other 0 0.000000 0.0000 0.0000
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Total 2967 15827.750000 59296.9500 20355.2900