CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 Page: 1
List order: No List
Agency Filter:EXT
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 3.250000 120.9000 37.2000
Subtotal (Total Children Is Unduplicated) 1 3.250000 120.9000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 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 1 2.000000 111.0000 55.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 5 13.000000 912.4100 70.1854
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 17 16.000000 800.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 27 30.000000 1500.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 8.500000 212.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 26 53.750000 2687.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 26.750000 1337.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 21 78.000000 3900.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 5.500000 275.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 18.000000 900.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 367 1840.000000 18400.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 1 0.750000 53.9700 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 7.000000 503.7200 71.9600
TRAV-TRAVS-Travel by mile 194 10839.00000 4822.5000 0.4449
Subtotal (Total Children Is Unduplicated) 384 12926.75000 35574.1100 2.7520
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Total 12943.000000 36607.4200 2.8284
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Number of Children (Unduplicated) With at Least One Service 387
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Center 52
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 1655 12937.750000 36386.5200 36386.5200
2 3.250000 120.9000 0.0000
Other 1 2.000000 100.0000 100.0000
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Total 1658 12943.000000 36607.4200 36486.5200