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
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 1042 1650.500000 61013.0000 36.9664
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 36 35.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 429 746.750000 27629.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1158 2432.500000 88642.7500 36.4410
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 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-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 12.000000 900.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 13.000000 975.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 23 43.000000 2386.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
Subtotal (Total Children Is Unduplicated) 36 91.500000 5985.0000 65.4098
-----------------------------------------------------------------------------------------------------------------------
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 5 9.000000 450.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 17.500000 875.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 295 1141.000000 11410.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 23.000000 1643.1200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 5.000000 357.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 7.000000 500.0800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 12.000000 857.2800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 21.000000 1500.2400 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 37 44.500000 1646.5000 37.0000
Subtotal (Total Children Is Unduplicated) 460 2651.000000 42597.4900 16.0685
-----------------------------------------------------------------------------------------------------------------------
Total 5175.000000 137225.2400 26.5170
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1244
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 10 7.000000 317.0000 0.0000
S 310 149.000000 5503.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7658 4989.250000 130303.7400 0.0000
Other 33 29.750000 1100.7500 0.0000
---------------------------------------------------------
Total 8011 5175.000000 137225.2400 0.0000