CMS/EIP Fiscal Report Center: 09
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 1783 5083.750000 189087.5000 37.1945
TCM-T1017TL-TARGETED CASE MANAGEMENT 1795 6724.750000 249919.0000 37.1641
Subtotal (Total Children Is Unduplicated) 2020 11808.50000 439006.5000 37.1772
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 201 277.000000 13850.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 5.500000 412.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 14 23.500000 1255.1100 53.4089
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 108 184.500000 13787.5000 74.7290
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 79 135.000000 10030.0000 74.2963
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 24 47.500000 3562.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 265 482.500000 26678.7500 55.2927
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 562 1171.500000 70564.0500 60.2339
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 7.000000 350.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 23 39.500000 1975.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 17 19.750000 493.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 1.000000 50.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 6.000000 300.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 5 3.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 35 141.000000 7050.0000 50.0000
INTR-T1013-INTERPRETER 113 455.000000 22750.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 6.000000 431.7600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 4 15.250000 1097.3900 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 7 26.000000 1870.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 287.8400 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 9 22.000000 1583.1200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 10.750000 773.5700 71.9600
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.9600 13.9600
TRAV-TRAVS-Travel by mile 4 5.000000 2.2000 0.4400
Subtotal (Total Children Is Unduplicated) 196 769.750000 39354.5500 51.1264
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Total 13749.750000 548925.1000 39.9226
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Number of Children (Unduplicated) With at Least One Service 2056
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Center 09
Flag Claims Units Chgs Paid
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R 7 4.000000 148.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 1726 1924.750000 77599.4700 5074.7600
P 8469 8445.750000 330736.0800 330968.4300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 215 321.500000 17996.6000 0.0000
T 2875 2814.000000 109321.8300 109321.2300
161 234.250000 12881.1200 0.0000
Other 5 5.500000 241.2000 0.0000
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Total 13458 13749.750000 548925.1000 445364.4200