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
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 384 168.500000 6268.2000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 32 15.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 323 807.750000 29908.8000 37.0273
Subtotal (Total Children Is Unduplicated) 587 991.500000 36177.0000 36.4871
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 20.0000 10.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 7 12.000000 565.4100 47.1175
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 46 47.250000 2362.5000 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 139 221.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 24.500000 1225.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 221 1280.000000 12800.0000 10.0000
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 8.000000 575.6800 71.9600
TRAV-TRAVS-Travel by mile 258 16836.00000 7490.6900 0.4449
Subtotal (Total Children Is Unduplicated) 378 18570.25000 31880.2200 1.7167
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Total 19573.750000 68622.6300 3.5058
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Number of Children (Unduplicated) With at Least One Service 745
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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 1 0.250000 9.3000 9.3000
D 17 19.500000 1008.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1496 18279.500000 28387.7200 27134.6800
2187 1274.500000 39217.6100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3701 19573.750000 68622.6300 27143.9800