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:TPIN
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 3 5.750000 213.9000 37.2000
Subtotal (Total Children Is Unduplicated) 3 5.750000 213.9000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 45 97.000000 6895.0000 71.0825
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 38.000000 2850.0000 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 5 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 59 118.000000 6549.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 8.000000 344.3400 43.0425
Subtotal (Total Children Is Unduplicated) 100 306.000000 19566.7500 63.9436
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 1.000000 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 108 607.500000 30310.0000 49.8930
OCCT-97530-OT SESSION BY LICENSED OT 2 5.000000 359.8000 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 5.000000 288.0000 57.6000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 193.250000 12786.2000 66.1640
Subtotal (Total Children Is Unduplicated) 146 813.750000 43844.0000 53.8790
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Total 1125.500000 63624.6500 56.5301
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Number of Children (Unduplicated) With at Least One Service 217
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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 56 75.000000 3998.2000 2832.9000
D 238 250.500000 13494.0000 165.0000
S 2 2.750000 203.9700 130.0000
H 222 264.000000 15552.5500 0.0000
T 402 426.500000 23796.5000 16580.2200
92 106.750000 6579.4300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1012 1125.500000 63624.6500 19708.1200