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
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 1094 656.750000 24392.1000 37.1406
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 116 68.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 642 3194.750000 118223.8500 37.0057
Subtotal (Total Children Is Unduplicated) 1338 3919.500000 142615.9500 36.3863
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 38.000000 1706.4000 44.9053
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1050.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 36.000000 1998.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 35 104.000000 5826.4000 56.0231
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 124 150.750000 7537.5000 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 323 809.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 24 105.000000 5107.8000 48.6457
INTR-T1013-INTERPRETER 1 3.250000 162.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 417 4879.000000 48790.0000 10.0000
OCCT-97530HM-OT SESSION BY OT ASST 2 4.000000 230.4000 57.6000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 17.000000 1015.2400 59.7200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
TRAV-TRAVS-Travel by mile 620 68017.00000 30262.5700 0.4449
Subtotal (Total Children Is Unduplicated) 833 74518.00000 119068.6800 1.5979
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Total 78541.500000 267511.0300 3.4060
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Number of Children (Unduplicated) With at Least One Service 1478
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Center 52
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 2 0.500000 18.5500 18.5500
D 72 86.500000 4586.6000 0.0000
S 24 13.000000 576.0000 0.0000
H 1 3.000000 111.0000 0.0000
T 5808 73214.750000 108322.9300 103325.9600
8422 5217.750000 153673.3500 93.4000
Other 5 6.000000 222.6000 0.0000
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Total 14334 78541.500000 267511.0300 103437.9100