CMS/EIP Fiscal Report Center: 55
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
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 870 731.250000 27286.2000 37.3145
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 105 83.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1118 4161.500000 154752.0000 37.1866
Subtotal (Total Children Is Unduplicated) 1182 4976.500000 182038.2000 36.5796
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 36.000000 2700.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 14.000000 816.0000 58.2857
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 128 257.000000 19275.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 15 30.000000 2250.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 37 73.000000 4051.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 18 36.000000 1998.0000 55.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
Subtotal (Total Children Is Unduplicated) 184 466.000000 32401.7800 69.5317
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 17 17.000000 850.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 16.000000 800.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 8.000000 200.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 36 207.000000 10350.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 12.000000 600.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 26.500000 1906.9400 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 16 76.750000 5522.9300 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 69 367.250000 20401.8300 55.5530
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Total 5809.750000 234841.8100 40.4220
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Number of Children (Unduplicated) With at Least One Service 1184
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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 1636 1516.250000 65703.0400 0.0000
P 1092 983.000000 39560.7000 38626.2000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 26 47.500000 3551.8600 0.0000
T 0 0.000000 0.0000 0.0000
4519 3263.000000 126026.2100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7273 5809.750000 234841.8100 38626.2000