CMS/EIP Fiscal Report Center: 55
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 961 1004.250000 37348.7000 37.1906
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 85 53.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1078 3434.250000 127620.5500 37.1611
Subtotal (Total Children Is Unduplicated) 1161 4491.750000 164969.2500 36.7272
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 22 45.000000 2250.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 5 10.000000 500.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 9 14.000000 700.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 93 186.500000 13987.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 17 34.000000 2550.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 72.000000 3996.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
Subtotal (Total Children Is Unduplicated) 159 398.500000 26322.0000 66.0527
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 17 17.000000 850.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 17.000000 850.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 9.000000 450.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 40 222.000000 11100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 15.000000 750.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 96.250000 6926.1500 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 2.750000 197.8900 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 37.000000 2662.5200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 68 419.000000 23908.5200 57.0609
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Total 5309.250000 215199.7700 40.5330
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Number of Children (Unduplicated) With at Least One Service 1166
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Center 55
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 1904 1560.750000 66717.5100 0.0000
P 835 755.250000 30443.9500 30443.8000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 38 52.500000 3676.5900 0.0000
T 0 0.000000 0.0000 0.0000
4793 2940.750000 114361.7200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7570 5309.250000 215199.7700 30443.8000