CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2022 ending 09/30/2022 Date of Report:10/18/2022 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 972 1456.250000 53894.0500 37.0088
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 30 30.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1061 2032.750000 75202.5000 36.9954
Subtotal (Total Children Is Unduplicated) 1241 3519.750000 129096.5500 36.6778
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 2.000000 97.0000 48.5000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 5 8.000000 400.0000 50.0000
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 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 9.500000 712.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 54 97.500000 7312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 7.500000 562.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 32 57.500000 4275.0000 74.3478
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 41 69.500000 5212.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 103 186.000000 10323.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.500000 1012.5000 75.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 105.1400 52.5700
Subtotal (Total Children Is Unduplicated) 184 516.000000 34484.1400 66.8297
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.000000 214.3200 71.4400
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 2.750000 137.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 9 6.500000 325.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 9.000000 450.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 134 108.750000 5425.0000 49.8851
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 10.500000 525.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 81 50.250000 2512.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 34 44.750000 2237.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 159 70.250000 3500.0000 49.8221
CONPP-CONPP-CONSULT, PT, PHONE 6 1.750000 43.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 22 22.750000 1137.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 158 85.750000 4287.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 4.000000 100.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 341 1010.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 135 468.250000 23412.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 114 275.250000 13762.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 340 1407.000000 14070.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 21 63.000000 4538.2600 72.0359
OCCT-97530GT-OT SESSION BY LICENSED OT 7 8.000000 571.5200 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 14 38.500000 2754.3400 71.5413
OCCT-97530TLGT-OT SESSION BY LICENSED OT 4 5.000000 357.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 23 120.500000 8616.8400 71.5090
PHY-97110GT-PT SESSION BY LICENSED PT 8 11.750000 839.4200 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 37 197.750000 14138.1800 71.4952
PHY-97110TLGT-PT SESSION BY LICENSED PT 11 17.500000 1250.2000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 47 184.500000 13197.7100 71.5323
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 26 67.750000 4845.2600 71.5168
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 48 207.250000 14855.9900 71.6815
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 28 74.750000 5345.3400 71.5096
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 26 33.250000 1230.2500 37.0000
Subtotal (Total Children Is Unduplicated) 506 4613.500000 144793.5800 31.3848
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Total 8649.250000 308374.2700 35.6533
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Number of Children (Unduplicated) With at Least One Service 1327
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Center 53
Flag Claims Units Chgs Paid
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R 62 54.500000 2933.1600 0.0000
U 0 0.000000 0.0000 0.0000
B 1273 1186.500000 61429.0100 9.2500
P 1139 1032.500000 49617.8800 49617.8800
D 154 107.500000 5593.1500 0.0000
S 378 233.250000 10242.0500 0.0000
H 6 4.500000 316.1200 0.0000
T 0 0.000000 0.0000 0.0000
8623 5923.250000 173983.5700 0.0000
Other 143 107.250000 4259.3300 9.2500
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Total 11778 8649.250000 308374.2700 49636.3800