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
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 782 620.500000 23060.8000 37.1649
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 76 56.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 636 1567.000000 58194.9000 37.1378
Subtotal (Total Children Is Unduplicated) 1153 2244.250000 81255.7000 36.2062
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 17.000000 824.5000 48.5000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 18.000000 1350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 8.000000 600.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 11.500000 862.5000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 48 92.500000 6159.7500 66.5919
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 19.000000 1367.2400 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 405 1277.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 14.000000 700.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 20.000000 1000.0000 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 10 31.500000 2266.7400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 6 8.500000 611.6600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 12 56.500000 4065.7400 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 4 6.000000 431.7600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 72.000000 5181.1200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 215.8800 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 37 35.000000 1295.0000 37.0000
Subtotal (Total Children Is Unduplicated) 623 3798.250000 68327.6400 17.9892
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Total 6135.000000 155743.0900 25.3860
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Number of Children (Unduplicated) With at Least One Service 1273
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Center 54
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 127 85.000000 3820.2400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8501 6021.000000 150769.4500 0.0000
Other 39 28.500000 1134.8000 0.0000
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Total 8667 6134.500000 155724.4900 0.0000