CMS/EIP Fiscal Report Center: 55
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
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 1979 3876.250000 143994.1500 37.1478
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 309 344.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2018 17067.75000 632674.1000 37.0684
Subtotal (Total Children Is Unduplicated) 2087 21288.25000 776668.2500 36.4834
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 65 135.000000 6750.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 20 41.000000 2050.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 36 65.000000 3250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 28 56.000000 4200.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 600.0000 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 629 1257.379992 94303.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 91 181.999998 13650.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.999999 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 250 517.999998 28749.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 44 88.000000 4884.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92521TL-EVAL OF SPEECH FLUENCY 2 3.000000 154.2300 51.4100
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 21.000000 1078.1700 51.3414
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 5.000000 257.0500 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
Subtotal (Total Children Is Unduplicated) 890 2391.379987 160686.0400 67.1939
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 5.500000 275.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 60 83.000000 4150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 8 9.000000 225.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 67 87.000000 4350.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 8 11.000000 275.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 40.000000 2000.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 87 1082.500000 54125.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 58.000000 2900.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 316.915504 22774.0400 71.8616
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 5.500000 395.3900 71.8891
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 19 253.000000 18180.9200 71.8613
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 6.250000 449.3600 71.8976
Subtotal (Total Children Is Unduplicated) 149 1957.665504 110099.7100 56.2403
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Total 25637.295491 1047454.0000 40.8566
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Number of Children (Unduplicated) With at Least One Service 2093
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Center 55
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 3497 3293.750000 148008.8000 0.0000
P 9374 8683.416666 358797.9500 358447.7400
D 1 0.250000 9.3000 0.0000
S 10 12.913867 892.5400 37.5000
H 141 214.165509 15528.5900 0.0000
T 0 0.000000 0.0000 0.0000
19935 13432.549449 524207.5200 0.0000
Other 1 0.250000 9.3000 9.3000
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Total 32959 25637.295491 1047454.0000 358494.5400