CMS/EIP Fiscal Report Center: 09
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 1852 5742.500000 213593.1000 37.1951
TCM-T1017TL-TARGETED CASE MANAGEMENT 828 3286.750000 122211.3000 37.1830
Subtotal (Total Children Is Unduplicated) 1960 9029.250000 335804.4000 37.1907
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 195 281.500000 14075.0000 50.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 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 12 21.500000 1612.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 17.000000 1275.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 30 57.500000 3191.2500 55.5000
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 250 398.000000 21581.4800 54.2248
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 8.000000 400.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 18 37.500000 1875.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 28 28.500000 712.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 6.000000 300.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 46 80.500000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 3.000000 150.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 14 56.000000 2800.0000 50.0000
INTR-T1013-INTERPRETER 104 430.250000 21512.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 19.000000 1367.2400 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 31.500000 2266.7400 71.9600
Subtotal (Total Children Is Unduplicated) 198 711.250000 31955.9400 44.9293
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Total 10138.500000 389341.8200 38.4023
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Number of Children (Unduplicated) With at Least One Service 1993
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Center 09
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 6498 6287.250000 241403.6400 241403.6400
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 32 34.750000 1395.1000 1395.1000
3902 3816.500000 146543.0800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10432 10138.500000 389341.8200 242798.7400