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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 8.250000 306.9000 37.2000
Subtotal (Total Children Is Unduplicated) 3 8.250000 306.9000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 31.500000 1748.0200 55.4927
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 18.000000 1350.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 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 13 26.000000 1443.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 227 497.750000 33777.2500 67.8599
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 84 168.000000 12600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 47 96.000000 7030.0000 73.2292
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 18.000000 1010.0000 56.1111
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 233 467.500000 25813.2500 55.2155
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 999.0000 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 30 31.000000 1504.0000 48.5161
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 18 22.000000 1018.3100 46.2868
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 14 81.000000 3815.3900 47.1036
Subtotal (Total Children Is Unduplicated) 379 1500.250000 93997.1300 62.6543
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 4 3.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 6 7.500000 375.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 175 2092.500000 100681.2500 48.1153
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 3.750000 187.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 2.000000 20.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 31.500000 2139.8000 67.9302
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 2 16.000000 507.7200 31.7325
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 76 811.250000 52918.4800 65.2308
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 2.000000 124.3700 62.1850
Subtotal (Total Children Is Unduplicated) 250 2970.750000 157026.0800 52.8574
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Total 4479.250000 251330.1100 56.1099
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Number of Children (Unduplicated) With at Least One Service 482
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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 406 562.500000 30604.4500 21993.2600
D 968 1071.500000 57538.3800 535.3000
S 3 6.000000 450.0000 410.0000
H 389 503.000000 32887.5400 0.0000
T 1946 2117.000000 116735.9400 82802.7300
181 219.250000 13113.8000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3893 4479.250000 251330.1100 105741.2900