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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 5.000000 242.5000 48.5000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 8.2500 4.1250
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 20.500000 1537.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 20.500000 1137.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 32 50.500000 2802.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 53.000000 3975.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 74.000000 5459.9300 73.7828
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 6.000000 317.5800 52.9300
Subtotal (Total Children Is Unduplicated) 142 253.500000 16953.9200 66.8794
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 50 58.500000 2925.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 62 77.500000 3862.5000 49.8387
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 16 16.750000 418.7500 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 20 27.000000 1350.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 22 31.000000 1550.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 19.000000 950.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 13 18.000000 900.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 26 33.000000 1650.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 52 76.250000 3812.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 6.250000 312.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 367 1368.000000 68400.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 17 38.500000 1925.0000 50.0000
INTR-T1013-INTERPRETER 87 245.250000 12262.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1298 5887.000000 58780.0000 9.9847
OCCT-97530-OT SESSION BY LICENSED OT 11 47.000000 3382.1200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 4.000000 287.8400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 22 108.750000 7517.5700 69.1271
PHY-97110GT-PT SESSION BY LICENSED PT 3 3.000000 215.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 56 248.500000 17739.1800 71.3850
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 15 65.250000 4695.3900 71.9600
TRAV-TRAVS-Travel by mile 542 31198.00000 12909.3700 0.4138
Subtotal (Total Children Is Unduplicated) 1450 39706.50000 212158.6000 5.3432
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Total 39960.000000 229112.5200 5.7335
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Number of Children (Unduplicated) With at Least One Service 1533
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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 5259 23965.250000 101100.0900 101100.0900
D 606 3163.500000 11678.6300 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5168 12641.750000 104991.6800 104838.1000
7 33.000000 521.1200 0.0000
Other 92 156.500000 10821.0000 0.0000
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Total 11132 39960.000000 229112.5200 205938.1900