CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 Page: 1
List order: No List
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 360 286.750000 10600.5000 36.9677
Subtotal (Total Children Is Unduplicated) 360 286.750000 10600.5000 36.9677
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.000000 145.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 19 37.250000 1862.5000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 15.500000 860.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 17.000000 1275.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 80 129.500000 9712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 11.500000 862.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 44 71.500000 5362.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 8.500000 637.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 30.500000 1692.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 205 320.000000 17760.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 29.500000 2212.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 108 186.000000 13950.0000 75.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 329 881.750000 57684.6500 65.4206
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 73 80.750000 4037.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 75 90.750000 4537.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 24 24.000000 600.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 51 66.750000 3337.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 60 92.500000 4575.0000 49.4595
CONIP-CONIP-CONSULT, ITDS PHONE 9 8.500000 212.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 25 29.500000 1475.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 19 23.500000 1175.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 20 25.750000 1287.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 11 64.000000 750.0000 11.7188
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 44 51.000000 2550.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 40 64.750000 3237.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 10 10.000000 250.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 411 2072.000000 103600.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 97 207.750000 10387.5000 50.0000
INTR-T1013-INTERPRETER 83 205.750000 10249.0000 49.8129
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1240 7003.000000 70030.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 71.500000 5059.8400 70.7670
OCCT-97530GT-OT SESSION BY LICENSED OT 17 36.750000 2625.4200 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 5 6.000000 428.6400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 8 15.500000 1107.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 35 162.500000 11609.0000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 11 16.000000 1077.8200 67.3638
PHY-97110TL-PT SESSION BY LICENSED PT 9 17.000000 1214.4800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 10 17.500000 1250.2000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 74 358.500000 25410.0600 70.8788
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 27 82.250000 5875.9400 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 8 10.000000 714.4000 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 5.000000 357.2000 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 7 8.500000 314.5000 37.0000
TRAV-TRAVS-Travel by mile 381 24649.00000 10938.5900 0.4438
Subtotal (Total Children Is Unduplicated) 1462 35578.25000 290324.9100 8.1602
-----------------------------------------------------------------------------------------------------------------------
Total 36746.750000 358610.0600 9.7590
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1740
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 7034 17204.500000 161265.1400 161215.1400
D 1269 5358.750000 32045.4300 0.0000
S 636 577.000000 31986.1700 0.0000
H 124 137.750000 8930.7600 0.0000
T 4232 12969.250000 95233.3400 94717.5700
350 319.750000 17670.2200 0.0000
Other 113 179.750000 11479.0000 0.0000
---------------------------------------------------------
Total 13758 36746.750000 358610.0600 255932.7100