CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 902 484.500000 17926.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6 2.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 868 2169.500000 80253.0000 36.9915
Subtotal (Total Children Is Unduplicated) 1415 2656.250000 98179.5000 36.9617
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 3 6.000000 300.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 15 25.500000 1912.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 12.000000 900.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 15 27.000000 1498.5000 55.5000
Subtotal (Total Children Is Unduplicated) 25 79.000000 5219.2500 66.0665
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 12.6600 12.6600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 50 43.000000 2050.0000 47.6744
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 9 7.500000 375.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 84 65.250000 1631.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 2 3.000000 150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 15 13.500000 335.0000 24.8148
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 5.000000 125.0000 25.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 10 10.500000 262.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 5 10.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 320 2044.750000 101737.5000 49.7555
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 72 213.000000 10550.0000 49.5305
INTR-T1013-INTERPRETER 4 30.000000 2400.0000 80.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1114 7553.000000 75290.0000 9.9682
OCCT-97530-OT SESSION BY LICENSED OT 2 7.000000 500.0800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 2.000000 0.0000 0.0000
PHY-97110-PT SESSION BY LICENSED PT 4 24.000000 1714.5600 71.4400
SENS-V5060-BEHIND EAR HEARING AID 1 1.000000 228.0000 228.0000
SENS-V5264-EARMOLD 2 2.000000 30.6500 15.3250
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 12.000000 857.2800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 285.7600 71.4400
Subtotal (Total Children Is Unduplicated) 1161 10060.50000 198960.2400 19.7764
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Total 12795.750000 302358.9900 23.6296
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Number of Children (Unduplicated) With at Least One Service 1966
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Center 06
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 8399 8340.250000 167007.1500 167007.1500
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
5692 4120.500000 122975.3400 0.0000
Other 446 335.000000 12376.5000 0.0000
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Total 14537 12795.750000 302358.9900 167007.1500