CMS/EIP Fiscal Report Center: 52
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 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 1094 656.750000 24392.1000 37.1406
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 116 68.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1522 7705.500000 285388.6000 37.0370
Subtotal (Total Children Is Unduplicated) 1656 8430.250000 309780.7000 36.7463
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 31 68.000000 4485.5200 65.9635
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 30.000000 2250.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 12.500000 937.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 34 68.000000 3774.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 507 1069.000000 75477.4000 70.6056
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 15 30.000000 2250.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 215 432.000000 32400.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 18.000000 1350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 95 199.500000 14792.5000 74.1479
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 30.000000 1910.0000 63.6667
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 569 1138.000000 63026.0000 55.3831
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 17 34.000000 1887.0000 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 85 86.000000 4254.0000 49.4651
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 18 22.000000 1018.3100 46.2868
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 18 18.000000 925.0200 51.3900
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 15 82.000000 3867.9600 47.1702
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 12 77.000000 4068.6100 52.8391
Subtotal (Total Children Is Unduplicated) 883 3419.000000 219025.2300 64.0612
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 125 152.000000 7600.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 89 90.000000 4500.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 35 27.750000 693.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 114 216.500000 10825.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 4 3.500000 175.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 22 31.500000 1575.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 9.500000 475.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 82 141.750000 7087.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 7 6.250000 312.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 323 812.500000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 8 8.500000 425.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 410 4777.250000 234776.5500 49.1447
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 13.000000 650.0000 50.0000
INTR-T1013-INTERPRETER 1 3.250000 162.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 417 4885.000000 48840.0000 9.9980
OCCT-97530-OT SESSION BY LICENSED OT 6 43.500000 2999.6800 68.9582
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 143.4000 71.7000
OCCT-97530HM-OT SESSION BY OT ASST 3 24.000000 968.5200 40.3550
OCCT-97530TL-OT SESSION BY LICENSED OT 1 8.000000 575.6800 71.9600
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 85 845.250000 55136.4600 65.2309
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 2.000000 124.3700 62.1850
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 60 493.500000 35283.1300 71.4957
TRAV-TRAVS-Travel by mile 620 68036.00000 30267.9100 0.4449
Subtotal (Total Children Is Unduplicated) 834 80636.50000 443779.5500 5.5035
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Total 92485.750000 972585.4800 10.5161
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Number of Children (Unduplicated) With at Least One Service 1659
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Center 52
Flag Claims Units Chgs Paid
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R 11 8.750000 451.9200 0.0000
U 0 0.000000 0.0000 0.0000
B 1857 1867.500000 101343.0200 55.8000
P 7056 7465.750000 351968.8600 463334.3400
D 1109 1250.750000 67720.7300 2103.2000
S 542 471.750000 20740.0500 2168.4000
H 403 519.000000 33846.1800 0.0000
T 7755 75332.750000 225130.8300 186128.6900
8719 5561.500000 171011.2900 513.9400
Other 6 8.000000 372.6000 150.0000
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Total 27458 92485.750000 972585.4800 654454.3700