CMS/EIP Fiscal Report Center: 09
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 1965 6320.000000 233803.0000 36.9941
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 3.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 810 3384.500000 125226.5000 37.0000
Subtotal (Total Children Is Unduplicated) 2026 9707.500000 359029.5000 36.9848
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 104 170.250000 8512.5000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 61 115.500000 8662.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 27 52.500000 3937.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 59 111.500000 8362.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 61 115.000000 6382.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 29.000000 2175.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 4.000000 200.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 5.000000 229.7300 45.9460
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 250 631.250000 40434.8300 64.0552
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 199.5000 66.5000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 74 104.250000 5212.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 32 57.500000 2875.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 82 95.750000 2393.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 11.000000 550.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 12 14.000000 700.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 23.000000 1150.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 9 11.000000 550.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 7.000000 350.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 14.000000 700.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 5 6.000000 300.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 7.000000 350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 295 1569.500000 78475.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 17 67.000000 3350.0000 50.0000
INTR-T1013-INTERPRETER 85 305.750000 15237.5000 49.8365
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 33 190.000000 1900.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 78 388.250000 27736.5800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 11.000000 785.8400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 68 346.500000 24753.9600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 8 41.000000 2929.0400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 206 1165.750000 82781.1000 71.0110
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 10 34.000000 2428.9600 71.4400
TRAV-TRAVS-Travel by mile 910 81731.00000 35860.7100 0.4388
Subtotal (Total Children Is Unduplicated) 1151 86205.25000 291619.4400 3.3829
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Total 96544.000000 691083.7700 7.1582
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Number of Children (Unduplicated) With at Least One Service 2093
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Center 09
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 9667 65339.000000 471316.3300 471316.3300
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
4814 31152.000000 215933.9400 0.0000
Other 29 53.000000 3833.5000 0.0000
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Total 14510 96544.000000 691083.7700 471316.3300