CMS/EIP Fiscal Report Center: 54
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 782 620.500000 23060.8000 37.1649
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 76 56.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1478 4535.000000 168506.6000 37.1569
Subtotal (Total Children Is Unduplicated) 1526 5212.250000 191567.4000 36.7533
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 17.000000 824.5000 48.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 12 22.500000 1687.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 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 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 12.000000 900.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 22 41.500000 3112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 40.500000 3037.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 62 114.500000 8587.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 27.500000 2062.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 24 43.500000 3262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 26 51.000000 2830.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 34.000000 2550.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 45 87.500000 6562.5000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 220 538.500000 38644.5000 71.7632
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 14 36.000000 2590.5600 71.9600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 41 30.750000 1537.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 105 120.750000 6037.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 29 13.250000 650.0000 49.0566
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 227 112.000000 5587.5000 49.8884
CONOF-CONOF-CONSULT, OT, FACE TO FACE 26 26.000000 1300.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 286 132.000000 6587.5000 49.9053
CONPF-CONPF-CONSULT, PT, FACE TO FACE 32 32.000000 1600.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 217 86.500000 4325.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 46 58.750000 2937.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 198 103.500000 5175.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 406 1281.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 100 304.000000 15200.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 96 273.500000 13675.0000 50.0000
INTR-T1013-INTERPRETER 1 1.250000 62.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 403 1538.000000 15380.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 49 161.750000 11639.5300 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 26 36.000000 2590.5600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 51 225.250000 16208.9900 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 23 45.500000 3274.1800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 47 198.500000 14284.0600 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 12 19.000000 1367.2400 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 45 191.250000 13762.3500 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 13 16.000000 1151.3600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 161.000000 11585.5600 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 15 21.250000 1529.1500 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 31 114.500000 8177.4600 71.4189
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 16 43.000000 3094.2800 71.9600
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.9600 13.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 37 35.000000 1295.0000 37.0000
Subtotal (Total Children Is Unduplicated) 650 5419.500000 172631.7400 31.8538
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Total 11170.250000 402843.6400 36.0640
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Number of Children (Unduplicated) With at Least One Service 1545
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Center 54
Flag Claims Units Chgs Paid
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R 32 34.000000 2210.2200 0.0000
U 0 0.000000 0.0000 0.0000
B 1054 963.250000 45400.8100 9.3000
P 3723 3188.750000 147542.3100 147333.4000
D 251 211.750000 10787.8900 0.0000
S 0 0.000000 0.0000 0.0000
H 23 22.500000 1619.1000 0.0000
T 0 0.000000 0.0000 0.0000
9077 6635.250000 190314.1500 0.0000
Other 151 114.250000 4950.5600 1147.2000
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Total 14311 11169.750000 402825.0400 148489.9000