CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2021 ending 06/30/2022 Date of Report:08/08/2022 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 280 533.750000 19739.5000 36.9827
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 7.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 308 1552.750000 57451.7500 37.0000
Subtotal (Total Children Is Unduplicated) 312 2093.500000 77191.2500 36.8719
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 11.500000 862.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 12.500000 937.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 4.500000 337.5000 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 12 20.500000 1137.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.000000 825.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 108 176.000000 13200.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 11.000000 825.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 91 146.500000 10987.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 40 60.500000 4537.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 36.000000 1998.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 190 305.000000 16927.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 57.000000 4275.0000 75.0000
Subtotal (Total Children Is Unduplicated) 282 868.000000 58021.5000 66.8450
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 0.250000 12.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 2.750000 137.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 0.250000 12.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 6 7.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 3.000000 150.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 18.000000 900.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10 12.000000 120.0000 10.0000
PHY-97110GT-PT SESSION BY LICENSED PT 1 3.000000 214.3200 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 3 1.750000 64.7500 37.0000
TRAV-TRAVS-Travel by mile 3 136.000000 60.5200 0.4450
Subtotal (Total Children Is Unduplicated) 14 184.250000 1672.0900 9.0751
-----------------------------------------------------------------------------------------------------------------------
Total 3145.750000 136884.8400 43.5142
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 314
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 20 29.250000 1983.0000 0.0000
P 941 1062.500000 50077.0000 50049.2500
D 13 14.250000 527.2500 0.0000
S 128 69.750000 2637.7500 0.0000
H 16 19.500000 987.5000 0.0000
T 33 169.250000 1641.7700 1641.7700
2062 1716.500000 75492.5700 0.0000
Other 51 57.750000 3013.0000 9.2500
---------------------------------------------------------
Total 3264 3138.750000 136359.8400 51700.2700