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:MED
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 423 1263.250000 46490.5000 36.8023
Subtotal (Total Children Is Unduplicated) 423 1263.250000 46490.5000 36.8023
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 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 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 61 119.000000 8925.0000 75.0000
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 19 38.000000 2850.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 24.000000 1800.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 43 85.000000 4717.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 91 308.500000 21041.1500 68.2047
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 112 656.250000 32737.5000 49.8857
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 22 97.750000 6983.2600 71.4400
Subtotal (Total Children Is Unduplicated) 132 755.000000 39792.2000 52.7049
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Total 2326.750000 107323.8500 46.1261
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Number of Children (Unduplicated) With at Least One Service 462
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Center 52
Flag Claims Units Chgs Paid
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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 1540 1593.750000 71741.6200 71503.5800
D 0 0.000000 0.0000 0.0000
S 29 35.250000 1540.1300 59.2500
H 2 1.250000 59.2500 9.2500
T 0 0.000000 0.0000 0.0000
31 35.750000 1426.5000 0.0000
Other 4 2.750000 101.7500 0.0000
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Total 2211 2326.750000 107323.8500 71609.0800