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: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 0.750000 27.7500 37.0000
Subtotal (Total Children Is Unduplicated) 2 0.750000 27.7500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
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 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 44 91.500000 6630.6500 72.4661
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 50.000000 3410.0000 68.2000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 16.000000 1200.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 8.000000 258.2000 32.2750
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 37 74.000000 4107.0000 55.5000
SCREEN-T1023-SCREENING 5 6.000000 250.0000 41.6667
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 65 265.500000 17229.9500 64.8962
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 56 291.750000 14497.5000 49.6915
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 27 174.000000 10655.1600 61.2366
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 7.750000 553.6600 71.4400
Subtotal (Total Children Is Unduplicated) 82 484.500000 26449.2800 54.5909
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Total 750.750000 43706.9800 58.2178
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Number of Children (Unduplicated) With at Least One Service 141
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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 50 70.500000 3497.0600 2410.8100
D 169 185.250000 9488.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 88 111.500000 6922.5000 0.0000
T 204 225.750000 13041.6500 8812.0500
114 157.750000 10757.2700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 625 750.750000 43706.9800 11222.8600