CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 Page: 1
List order: No List
Payclass Filters:GR
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 93 30.250000 1125.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 489 783.250000 29134.9500 37.1975
Subtotal (Total Children Is Unduplicated) 561 813.500000 30260.2500 37.1976
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 5.000000 242.5000 48.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 8.500000 471.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.500000 1087.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 18.500000 1297.4300 70.1314
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 26 59.000000 3905.8400 66.2007
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 68 81.000000 4050.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 66 86.000000 4287.5000 49.8547
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 23 22.250000 556.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 30 34.000000 1700.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 66 88.500000 4425.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 5.000000 125.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 24 31.000000 1550.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 25 34.000000 1700.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 28 33.250000 1662.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 18 23.000000 1150.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 3.250000 81.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 37 44.000000 2200.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 54 78.250000 3912.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 4.750000 118.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 51 183.250000 9162.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 8.000000 400.0000 50.0000
INTR-T1013-INTERPRETER 87 246.250000 12312.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1298 5888.000000 58790.0000 9.9847
OCCT-97530-OT SESSION BY LICENSED OT 3 10.000000 719.6000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 10 33.750000 2120.5700 62.8317
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 30.750000 2212.7700 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 143.9200 71.9600
TRAV-TRAVS-Travel by mile 542 31198.00000 12909.3700 0.4138
Subtotal (Total Children Is Unduplicated) 1459 38172.25000 126436.9400 3.3123
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Total 39044.750000 160603.0300 4.1133
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Number of Children (Unduplicated) With at Least One Service 1731
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Center 01
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 4566 23264.750000 59833.9000 59833.9000
D 512 3066.500000 6430.2400 0.0000
S 4 1.750000 65.1000 0.0000
H 0 0.000000 0.0000 0.0000
T 4251 11717.750000 55288.2400 55268.2400
1587 994.000000 38985.5500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10920 39044.750000 160603.0300 115102.1400