CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 Page: 1
List order: No List
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 850 800.000000 29600.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1538 6682.750000 247261.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1584 7482.750000 276861.7500 37.0000
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 17 14.750000 737.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 55 39.750000 1987.5000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 8.000000 600.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 22 25.500000 1912.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 7 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 24 33.500000 1859.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 76 83.500000 6262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 182 215.500000 16162.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 286 521.500000 28915.5000 55.4468
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 138 177.500000 13312.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 67 67.000000 8065.6400 120.3827
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.1700 31.1700
NURS-T1001-NURSING ASSESSMENT 1 4.000000 200.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 306.3000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 14 14.000000 714.7000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162TLGT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 427 1251.000000 83305.4100 66.5911
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 14 21.000000 1050.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 965 5939.000000 296950.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 56 207.500000 10375.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 945 5965.000000 59650.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 40 126.250000 9019.3000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 21 103.000000 5891.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 22 61.500000 4309.5600 70.0741
PHY-97110HM-PT SESSION BY PT ASST 19 137.000000 7830.9200 57.1600
PHY-97110TLGTHM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 98.000000 7001.1200 71.4400
Subtotal (Total Children Is Unduplicated) 1089 12659.25000 402134.6600 31.7661
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Total 21393.000000 762301.8200 35.6332
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Number of Children (Unduplicated) With at Least One Service 1851
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Center 04
Flag Claims Units Chgs Paid
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R 12 16.000000 969.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2793 4332.500000 171923.4400 0.0000
P 2799 8333.500000 165446.8800 162475.1200
D 32 38.250000 1415.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 1615 5378.500000 272573.1700 0.0000
T 0 0.000000 0.0000 0.0000
3011 3173.250000 141690.6200 0.0000
Other 61 121.000000 8283.4600 0.0000
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Total 10323 21393.000000 762301.8200 162475.1200