CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 Page: 1
List order: No List
Agency Filter:EXT
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 2 0.750000 27.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 5 1.750000 64.7500 37.0000
Subtotal (Total Children Is Unduplicated) 7 2.500000 92.5000 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 29.1600 14.5800
EXIT-EXIT-EXIT ASSESSMENT 28 42.250000 2112.5000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 20.000000 1500.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 324.8800 40.6100
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 42.000000 2331.0000 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 3 6.000000 450.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 250.0000 62.5000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 18 18.000000 878.6500 48.8139
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 98 180.250000 10117.8900 56.1325
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 57 55.500000 2775.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 106 117.000000 5850.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 17 15.500000 387.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 226 346.500000 17325.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 138 233.500000 11675.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.500000 62.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 128 173.500000 8675.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 66 81.500000 4075.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 35 60.000000 3000.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 35 51.750000 2587.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 118 156.250000 7812.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 96 116.250000 5812.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 2.500000 62.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 382 2067.750000 103199.5000 49.9091
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 62 179.500000 8975.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1334 9430.000000 94585.0000 10.0302
OCCT-97530-OT SESSION BY LICENSED OT 23 118.750000 8363.5000 70.4295
OCCT-97530GT-OT SESSION BY LICENSED OT 3 3.000000 214.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 24 121.000000 7727.9000 63.8669
PHY-97110GT-PT SESSION BY LICENSED PT 3 6.750000 414.0000 61.3333
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 99 557.250000 35986.9200 64.5795
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 9 16.250000 1160.9000 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 1.000000 37.0000 37.0000
TRAV-TRAVS-Travel by mile 31 1428.000000 635.1900 0.4448
Subtotal (Total Children Is Unduplicated) 1380 15341.50000 331399.2300 21.6015
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Total 15524.250000 341609.6200 22.0049
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Number of Children (Unduplicated) With at Least One Service 1390
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Center 07
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 6064 15509.250000 341239.1200 341106.2400
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
9 15.000000 370.5000 290.0000
Other 0 0.000000 0.0000 0.0000
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Total 6073 15524.250000 341609.6200 341396.2400