CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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 384 158.500000 5877.6000 37.0826
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 38 21.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 330 750.500000 27927.9000 37.2124
Subtotal (Total Children Is Unduplicated) 622 930.000000 33805.5000 36.3500
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 56.000000 3108.0000 55.5000
Subtotal (Total Children Is Unduplicated) 34 72.000000 4230.0000 58.7500
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 40 45.250000 2312.5000 51.1050
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 10 8.500000 425.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 9.250000 231.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 58 112.500000 5625.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 1.750000 87.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 9.750000 487.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 20.000000 1000.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 0.250000 12.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 150 1519.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 23 90.250000 4512.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 5.000000 250.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 61 239.000000 3585.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 187 957.000000 11484.0000 12.0000
TRAV-TRAVS-Travel by mile 252 19400.00000 8631.0100 0.4449
Subtotal (Total Children Is Unduplicated) 402 22418.75000 38668.7600 1.7248
-----------------------------------------------------------------------------------------------------------------------
Total 23420.750000 76704.2600 3.2751
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 783
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 7 9.000000 637.2000 0.0000
S 142 83.000000 2966.7000 0.0000
H 0 0.000000 0.0000 0.0000
T 2514 20793.250000 33493.7600 31774.5600
2142 2535.500000 39606.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4805 23420.750000 76704.2600 31774.5600