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: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 384 168.500000 6268.2000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 32 15.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 805 2030.500000 75320.7000 37.0947
Subtotal (Total Children Is Unduplicated) 885 2214.250000 81588.9000 36.8472
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 22.500000 1687.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 26.000000 1443.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 105 220.000000 15990.0000 72.6818
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 59 118.000000 8850.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 26.000000 1950.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 154 307.000000 17038.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 24 24.000000 1200.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 8.000000 344.3400 43.0425
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 7 29.000000 1534.9700 52.9300
Subtotal (Total Children Is Unduplicated) 250 808.500000 51965.9500 64.2745
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 47 48.500000 2425.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 25 25.750000 1287.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 12 9.250000 231.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 48 71.750000 3587.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 8.500000 425.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 33 34.750000 1737.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 139 222.500000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 229 1325.250000 66197.5000 49.9510
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 3.750000 187.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 221 1284.000000 12830.0000 9.9922
OCCT-97530-OT SESSION BY LICENSED OT 3 7.000000 503.7200 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 2 10.000000 576.0000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 1 3.000000 215.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 40 202.250000 13414.8200 66.3279
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 26 100.000000 7106.0000 71.0600
TRAV-TRAVS-Travel by mile 258 16855.00000 7496.0300 0.4447
Subtotal (Total Children Is Unduplicated) 379 20215.25000 118421.2000 5.8580
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Total 23238.000000 251976.0500 10.8433
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Number of Children (Unduplicated) With at Least One Service 944
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Center 52
Flag Claims Units Chgs Paid
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R 17 19.000000 845.8400 0.0000
U 0 0.000000 0.0000 0.0000
B 826 835.000000 42160.2400 0.0000
P 1534 1585.250000 73642.8000 72478.1500
D 266 281.000000 15052.0000 515.0000
S 139 118.750000 5646.9200 700.1000
H 222 264.000000 15552.5500 0.0000
T 1898 18706.000000 52184.2200 43714.9000
2309 1429.000000 46891.4800 195.3400
Other 0 0.000000 0.0000 0.0000
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Total 7211 23238.000000 251976.0500 117603.4900