CMS/EIP Fiscal Report Center: 54
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 206 161.500000 6000.4000 37.1542
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 83 60.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 487 3561.500000 132254.2500 37.1344
Subtotal (Total Children Is Unduplicated) 487 3783.500000 138254.6500 36.5415
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 17 30.500000 2287.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 15.500000 1162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 24 45.000000 2497.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 23.000000 1725.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 69 121.500000 9112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 31.000000 2325.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 174 329.500000 24712.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 32.500000 2400.0000 73.8462
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 108 191.500000 14362.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 92.000000 5106.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 247 457.000000 25363.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 76.000000 5575.0000 73.3553
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 103 203.500000 15262.5000 75.0000
Subtotal (Total Children Is Unduplicated) 465 1706.500000 116017.7500 67.9858
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 1.750000 87.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.250000 12.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 0.500000 25.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 92 104.000000 0.0000 0.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 14.500000 725.0000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 70.0000 35.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 109 187.000000 1870.0000 10.0000
OCCT-97530TL-OT SESSION BY LICENSED OT 1 21.000000 1510.6400 71.9352
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 2.000000 143.4000 71.7000
PHY-97110TL-PT SESSION BY LICENSED PT 1 5.000000 357.2000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.750000 53.8400 71.7867
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 2 1.250000 46.2500 37.0000
TRAV-TRAVS-Travel by mile 53 770.000000 342.5100 0.4448
Subtotal (Total Children Is Unduplicated) 113 1112.000000 5343.8400 4.8056
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Total 6602.000000 259616.2400 39.3239
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Number of Children (Unduplicated) With at Least One Service 487
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Center 54
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 235 305.250000 14897.0600 0.0000
P 2168 2566.250000 114275.8200 113868.1400
D 52 53.000000 2648.2500 0.0000
S 2 3.250000 124.1000 0.0000
H 18 32.000000 2400.0000 0.0000
T 193 792.000000 12926.5300 12926.5300
2355 2829.500000 111232.4800 0.0000
Other 21 20.750000 1112.0000 82.5000
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Total 5044 6602.000000 259616.2400 126877.1700