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
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 14 48.000000 1784.4500 37.1760
Subtotal (Total Children Is Unduplicated) 14 48.000000 1784.4500 37.1760
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 15.000000 1125.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 26 47.500000 3712.5000 78.1579
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 29.500000 2212.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 71 137.500000 10312.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 20 35.500000 2662.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 24 44.000000 3300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 42.000000 3150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 50.000000 3750.0000 75.0000
Subtotal (Total Children Is Unduplicated) 185 436.500000 32536.5000 74.5395
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 22 53.000000 3807.6400 71.8423
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 3.000000 112.5000 37.5000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 34 220.000000 11000.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 31 151.000000 7550.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 50 412.840000 30519.4700 73.9257
OCCT-97530GT-OT SESSION BY LICENSED OT 36 142.620000 10720.4900 75.1682
OCCT-97530TL-OT SESSION BY LICENSED OT 3 5.000000 359.8000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 3.000000 214.8400 71.6133
PHY-97110-PT SESSION BY LICENSED PT 45 425.460000 32101.9200 75.4523
PHY-97110GT-PT SESSION BY LICENSED PT 22 48.750000 3499.3400 71.7813
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 47 380.180000 27351.9700 71.9448
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 25 56.250000 4040.2100 71.8260
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 287.8400 71.9600
Subtotal (Total Children Is Unduplicated) 197 1908.100000 131709.9400 69.0267
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Total 2392.600000 166030.8900 69.3935
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Number of Children (Unduplicated) With at Least One Service 304
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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 0 0.000000 0.0000 0.0000
P 75 64.520000 8117.6700 8054.2900
D 566 597.330000 37382.3200 0.0000
S 0 0.000000 0.0000 0.0000
H 453 501.750000 36064.9300 0.0000
T 0 0.000000 0.0000 0.0000
1108 1219.250000 83778.4200 0.0000
Other 10 9.750000 687.5500 0.0000
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Total 2212 2392.600000 166030.8900 8054.2900