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
Payclass Filters:GR
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 3876.000000 143984.8500 37.1478
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 309 344.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1458 7272.500000 270141.3500 37.1456
Subtotal (Total Children Is Unduplicated) 2055 11492.75000 414126.2000 36.0337
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 61 130.000000 6500.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 18 38.000000 1900.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 29 52.897400 2644.8700 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 104 182.489994 13686.7500 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 13 18.670399 1400.2800 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.170133 87.7600 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 87 176.856216 9815.5200 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 12 24.000000 1332.0000 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 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 296 635.084142 38168.5900 60.1001
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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 38 421.000000 21050.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 36.000000 1800.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 24.215033 1740.4400 71.8744
Subtotal (Total Children Is Unduplicated) 95 716.715033 35865.4400 50.0414
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Total 12844.549175 488160.2300 38.0052
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Number of Children (Unduplicated) With at Least One Service 2061
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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 0 0.000000 0.0000 0.0000
P 1 0.500000 18.6000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
19352 12844.049175 488141.6300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 19353 12844.549175 488160.2300 0.0000