CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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 93 30.250000 1125.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1611 2612.750000 97188.6000 37.1978
Subtotal (Total Children Is Unduplicated) 1633 2643.000000 98313.9000 37.1978
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 6.000000 450.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 22.000000 1650.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 10.500000 787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 17.000000 1275.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 4.500000 337.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 25.500000 1912.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 64.000000 3552.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 34 57.500000 3191.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 61 123.500000 9262.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 73.500000 5512.5000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 4.000000 211.7200 52.9300
Subtotal (Total Children Is Unduplicated) 185 423.500000 29204.9500 68.9609
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 20 22.500000 1125.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 6 8.500000 425.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 7 5.500000 137.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 3 3.000000 150.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 14.250000 712.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 5 5.000000 250.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 3.250000 81.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 11.000000 550.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 2 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 3.250000 81.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 46 89.000000 4450.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 22 33.000000 1650.0000 50.0000
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 31.000000 2230.7600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 4.250000 305.8300 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 8 18.000000 1295.2800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 18 37.750000 2716.4900 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 143.9200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 19 51.000000 3669.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 64.750000 4659.4100 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 143.9200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 7 12.750000 917.4900 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 9.000000 647.6400 71.9600
Subtotal (Total Children Is Unduplicated) 167 440.750000 26753.2000 60.6993
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Total 3507.250000 154272.0500 43.9866
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Number of Children (Unduplicated) With at Least One Service 1721
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Center 01
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 0 0.000000 0.0000 0.0000
S 3402 2264.500000 96996.8200 0.0000
H 150 180.000000 12223.5200 0.0000
T 2 2.000000 60.0000 60.0000
1655 1049.750000 44431.3100 0.0000
Other 25 11.000000 560.4000 0.0000
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Total 5234 3507.250000 154272.0500 60.0000