CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 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 1042 1650.500000 61013.0000 36.9664
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 36 35.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1136 2532.000000 93684.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1341 4217.750000 154697.0000 36.6776
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.500000 412.5000 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-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.500000 582.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 16.000000 1200.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 77 139.000000 10425.0000 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 43 80.500000 6037.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 57 94.000000 7050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 110 211.000000 11702.2500 55.4609
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 10.500000 787.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 43.000000 3225.0000 75.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 6.000000 315.4200 52.5700
Subtotal (Total Children Is Unduplicated) 250 655.000000 44506.9200 67.9495
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.000000 214.3200 71.4400
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 3.750000 187.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 15 14.250000 712.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 6 4.000000 200.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 141 94.000000 4700.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 16 15.250000 762.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 95 61.500000 3075.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 38 55.250000 2762.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 176 90.750000 4537.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 22 20.750000 1037.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 168 99.750000 4987.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 8 5.250000 131.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 293 901.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 93 300.750000 15037.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 159 444.500000 22225.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 295 1141.000000 11410.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 21 61.500000 4393.5600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 12 30.000000 2143.2000 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 22 60.000000 4286.4000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 23 45.500000 3250.5200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 19 110.500000 7894.1200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 14 33.250000 2375.3800 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 34 150.750000 10769.5800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 16 26.250000 1875.3000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 161.250000 11519.7000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 40 102.750000 7340.4600 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 41 132.000000 9430.0800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 52 166.250000 11876.9000 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 37 44.500000 1646.5000 37.0000
Subtotal (Total Children Is Unduplicated) 536 4381.750000 150832.2700 34.4228
-----------------------------------------------------------------------------------------------------------------------
Total 9254.500000 350036.1900 37.8233
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1399
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 17.500000 1130.0100 0.0000
P 623 672.500000 36608.3800 36608.3800
D 54 45.500000 2843.5800 0.0000
S 517 275.250000 10306.5000 0.0000
H 52 49.750000 2252.5100 0.0000
T 0 0.000000 0.0000 0.0000
11084 8131.500000 293852.7300 0.0000
Other 77 62.500000 3042.4800 0.0000
---------------------------------------------------------
Total 12420 9254.500000 350036.1900 36608.3800