CMS/EIP Fiscal Report Center: 52
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 376 157.750000 5868.2000 37.1994
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 23 12.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 675 1732.500000 64118.3500 37.0091
Subtotal (Total Children Is Unduplicated) 807 1903.000000 69986.5500 36.7770
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 0.500000 37.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 106 217.500000 15632.5000 71.8736
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 49 98.000000 7350.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 20.000000 1330.0000 66.5000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 105 209.500000 11627.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
SCREEN-T1023-SCREENING 18 19.000000 904.0000 47.5789
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 359.8700 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 308.4600 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 16.000000 781.0200 48.8138
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 4 10.000000 529.3000 52.9300
Subtotal (Total Children Is Unduplicated) 195 649.000000 41882.4000 64.5337
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 30 30.500000 1525.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 26 21.000000 1050.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 3.750000 93.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 23 31.250000 1562.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 2.750000 137.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 6.000000 300.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 4.000000 200.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 29 34.500000 1725.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 133 185.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 4 2.500000 125.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 221 1033.250000 51662.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 1.750000 87.5000 50.0000
INTR-T1013-INTERPRETER 1 1.500000 75.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 215 1110.000000 11100.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 6.000000 431.7600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 42 194.000000 13960.2400 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 23 106.500000 7663.7400 71.9600
TRAV-TRAVS-Travel by mile 237 14579.00000 6486.5800 0.4449
Subtotal (Total Children Is Unduplicated) 369 17354.25000 98258.0300 5.6619
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Total 19906.250000 210126.9800 10.5558
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Number of Children (Unduplicated) With at Least One Service 873
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Center 52
Flag Claims Units Chgs Paid
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R 35 36.750000 2493.7200 0.0000
U 0 0.000000 0.0000 0.0000
B 1028 1012.250000 48531.2900 27.9000
P 840 881.000000 42699.8900 162013.2700
D 229 241.250000 12709.7600 0.0000
S 106 77.000000 2901.4500 0.0000
H 129 164.750000 10719.2800 0.0000
T 1508 15921.750000 37127.7700 31515.5700
2277 1570.500000 52906.6200 30.0000
Other 1 1.000000 37.2000 0.0000
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Total 6153 19906.250000 210126.9800 193586.7400