CMS/EIP Fiscal Report Center: 54
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 761 566.750000 21083.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 75 58.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 598 1591.000000 59185.2000 37.2000
Subtotal (Total Children Is Unduplicated) 1118 2216.500000 80268.3000 36.2140
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 14 15.000000 727.5000 48.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 22.000000 1221.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 47 98.000000 6460.9100 65.9277
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 11 25.000000 1799.0000 71.9600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 29 25.250000 1262.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 101 99.500000 4975.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 9 4.750000 237.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 272 142.750000 7137.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 28 30.000000 1500.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 294 130.750000 6525.0000 49.9044
CONOP-CONOP-CONSULT, OT, PHONE 2 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 36 37.500000 1875.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 249 93.250000 4662.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 58 73.750000 3687.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 184 97.250000 4862.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 459 1426.250000 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 7 30.000000 1500.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 13.000000 650.0000 50.0000
INTR-T1013-INTERPRETER 1 3.250000 162.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 456 1750.000000 17500.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 13 35.000000 2518.6000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 8 17.000000 1223.3200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 15 63.000000 4533.4800 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 4.500000 323.8200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 62.750000 4515.4900 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 4.500000 323.8200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 287.8400 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 143.9200 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 22 26.750000 989.7500 37.0000
Subtotal (Total Children Is Unduplicated) 664 4205.500000 73315.2900 17.4332
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Total 6520.000000 160044.5000 24.5467
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Number of Children (Unduplicated) With at Least One Service 1261
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Center 54
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 148 104.750000 4910.8200 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8992 6378.250000 153757.2800 0.0000
Other 54 37.000000 1376.4000 0.0000
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Total 9194 6520.000000 160044.5000 0.0000