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
Payclass Filters:TPIN
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 4 3.000000 111.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 5 3.250000 120.2500 37.0000
Subtotal (Total Children Is Unduplicated) 6 6.250000 231.8500 37.0960
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 15.500000 1162.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 562.5000 70.3125
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 15.000000 1125.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 24 42.000000 2331.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 105.1400 52.5700
Subtotal (Total Children Is Unduplicated) 32 90.000000 5848.6400 64.9849
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.000000 214.3200 71.4400
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2 0.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 23 92.750000 4637.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 14 33.000000 1650.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 35.500000 2572.8800 72.4755
OCCT-97530GT-OT SESSION BY LICENSED OT 5 6.000000 428.6400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 16 110.500000 7902.4400 71.5153
PHY-97110GT-PT SESSION BY LICENSED PT 7 9.750000 696.5400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 129.000000 9227.0700 71.5277
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 17 43.750000 3129.1400 71.5232
Subtotal (Total Children Is Unduplicated) 91 464.000000 30458.5300 65.6434
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Total 560.250000 36539.0200 65.2191
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Number of Children (Unduplicated) With at Least One Service 118
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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 12 4.500000 167.1000 0.0000
S 5 7.500000 559.4600 0.0000
H 4 3.250000 232.1800 0.0000
T 0 0.000000 0.0000 0.0000
512 535.250000 34965.4500 0.0000
Other 11 9.750000 614.8300 0.0000
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Total 544 560.250000 36539.0200 0.0000