CMS/EIP Fiscal Report Center: 55
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 1076 1063.750000 39571.4000 37.1999
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 100 135.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1170 4733.000000 176067.6000 37.2000
Subtotal (Total Children Is Unduplicated) 1269 5932.000000 215639.0000 36.3518
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 15 29.000000 1450.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 3 5.000000 250.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 6 12.000000 600.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 18.000000 1350.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 195 388.999997 29175.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 16 31.999999 2400.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 69 138.000000 7659.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 20.000000 1110.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 4.000000 205.6400 51.4100
Subtotal (Total Children Is Unduplicated) 254 651.999996 44503.8700 68.2575
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 4.000000 200.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 18 18.000000 900.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 6 6.000000 150.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 16.000000 800.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 7.000000 175.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 12.000000 600.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 55 273.250000 13662.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 3.000000 150.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 14 92.500000 6656.3000 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 0.500000 35.9800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 8 59.000000 4245.6400 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 2.500000 179.9000 71.9600
Subtotal (Total Children Is Unduplicated) 85 493.750000 27755.3200 56.2133
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Total 7077.749996 287898.1900 40.6765
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Number of Children (Unduplicated) With at Least One Service 1274
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Center 55
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 2488 2371.250000 102124.4500 0.0000
P 952 887.000000 36310.8000 36310.8000
D 0 0.000000 0.0000 0.0000
S 2 3.273600 245.5200 0.0000
H 70 111.000000 8161.0700 0.0000
T 0 0.000000 0.0000 0.0000
5584 3705.226396 141056.3500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9096 7077.749996 287898.1900 36310.8000