CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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 977 554.750000 20636.7000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 2.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 804 2348.500000 87317.7000 37.1802
Subtotal (Total Children Is Unduplicated) 1375 2905.250000 107954.4000 37.1584
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 11.500000 862.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 12.500000 937.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 12 22.000000 1221.0000 55.5000
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 21 57.000000 3680.8700 64.5767
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EI Services,Class #03
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 2.250000 56.2500 25.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 47.000000 3382.1200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 3.500000 251.8600 71.9600
Subtotal (Total Children Is Unduplicated) 10 52.750000 3690.2300 69.9570
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Total 3015.000000 115325.5000 38.2506
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Number of Children (Unduplicated) With at Least One Service 1379
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Center 06
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 0 0.000000 0.0000 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
4726 2847.000000 108184.6800 0.0000
Other 261 168.000000 7140.8200 0.0000
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Total 4987 3015.000000 115325.5000 0.0000