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
Payclass Filters:GR
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 274 773.750000 28616.9000 36.9847
Subtotal (Total Children Is Unduplicated) 546 944.250000 34485.1000 36.5212
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 2 10.000000 711.0000 71.1000
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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 133 184.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 27.500000 1375.0000 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
TRAV-TRAVS-Travel by mile 237 14579.00000 6486.5800 0.4449
Subtotal (Total Children Is Unduplicated) 367 16037.00000 25680.3300 1.6013
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Total 16991.250000 60876.4300 3.5828
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Number of Children (Unduplicated) With at Least One Service 698
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Center 52
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 28 30.250000 1588.3000 0.0000
S 10 3.500000 129.8500 0.0000
H 0 0.000000 0.0000 0.0000
T 1275 15668.250000 22060.3300 21404.3900
2033 1288.250000 37060.7500 30.0000
Other 1 1.000000 37.2000 0.0000
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Total 3347 16991.250000 60876.4300 21434.3900