CMS/EIP Fiscal Report Center: 53
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 1038 1582.750000 58561.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 12.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 378 661.750000 24475.5000 36.9860
Subtotal (Total Children Is Unduplicated) 1148 2257.250000 83037.2500 36.7869
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 19.500000 1462.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 19.500000 1082.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
Subtotal (Total Children Is Unduplicated) 20 60.000000 4119.7500 68.6625
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 1.000000 50.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 16 15.500000 775.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 2.000000 100.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 142 111.500000 5575.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 19.750000 962.5000 48.7342
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 111 92.000000 4587.5000 49.8641
CONOP-CONOP-CONSULT, OT, PHONE 5 4.250000 106.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 31 55.000000 2750.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 179 116.750000 5787.5000 49.5717
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 24 21.500000 1075.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 173 104.000000 5200.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.750000 43.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 179 691.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 23.500000 1175.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 180 716.000000 7160.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 25.750000 1839.5800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 4 7.750000 553.6600 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 3.000000 214.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 8.000000 571.5200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 142.8800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.500000 35.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 7.500000 535.8000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 22.000000 1571.6800 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 42 50.000000 1850.0000 37.0000
Subtotal (Total Children Is Unduplicated) 384 2105.250000 42762.6600 20.3124
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Total 4422.500000 129919.6600 29.3770
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Number of Children (Unduplicated) With at Least One Service 1212
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Center 53
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 7 6.000000 325.3200 0.0000
S 176 71.250000 2670.6900 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6780 4302.750000 125360.4000 0.0000
Other 55 42.500000 1563.2500 0.0000
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Total 7018 4422.500000 129919.6600 0.0000