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:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 8 16.000000 1200.0000 75.0000
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.250000 62.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 11 32.000000 1600.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 4.000000 30.0000 7.5000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 20.0000 20.0000
TRAV-TRAVS-Travel by mile 2 19.000000 5.3400 0.2811
Subtotal (Total Children Is Unduplicated) 14 57.250000 1717.8400 30.0059
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Total 73.250000 2917.8400 39.8340
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Number of Children (Unduplicated) With at Least One Service 22
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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 0 0.000000 0.0000 0.0000
D 29 34.000000 1950.0000 1280.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
21 39.250000 967.8400 420.5400
Other 0 0.000000 0.0000 0.0000
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Total 50 73.250000 2917.8400 1700.5400