CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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 626 524.500000 19511.4000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 110 122.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 479 825.000000 30690.0000 37.2000
Subtotal (Total Children Is Unduplicated) 707 1472.000000 50201.4000 34.1042
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Screening, Eval, and Assessment,Class #02
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.8100 115.8100
EXIT-EXIT-EXIT ASSESSMENT 6 6.000000 300.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 39.000000 2925.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 18 37.500000 2812.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 48 88.500000 4856.2500 54.8729
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 22 39.000000 2164.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 62.000000 4650.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 27.500000 2062.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 105.7900 35.2633
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 20.1000 20.1000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 5.000000 264.6500 52.9300
Subtotal (Total Children Is Unduplicated) 120 333.000000 21751.8100 65.3208
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.000000 7511.1300 1877.7825
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 16.500000 825.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 11 15.000000 750.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 58 57.250000 2862.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 15 12.000000 600.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.750000 18.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 16.500000 825.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 16 10.750000 537.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.500000 75.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 15.000000 750.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 17 13.250000 662.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 99 460.000000 23000.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 33 131.250000 6562.5000 50.0000
INTR-T1013-INTERPRETER 20 88.250000 4412.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 284 1691.000000 16910.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 27 136.000000 9628.7700 70.7998
OCCT-97530GT-OT SESSION BY LICENSED OT 3 11.000000 791.5600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 15 60.500000 3320.8300 54.8898
PHY-97110GT-PT SESSION BY LICENSED PT 1 3.000000 215.8800 71.9600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 459.2200 459.2200
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 33 161.000000 11082.9600 68.8383
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 5.750000 413.7700 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 3 2.750000 101.7500 37.0000
TRAV-TRAVS-Travel by mile 181 13674.00000 6083.5000 0.4449
Subtotal (Total Children Is Unduplicated) 406 16594.00000 98611.8800 5.9426
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Total 18399.000000 170565.0900 9.2703
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Number of Children (Unduplicated) With at Least One Service 837
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Center 02
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 0 0.000000 0.0000 0.0000
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 2784 10315.250000 77974.7300 77957.9900
460 1318.500000 13122.9700 0.0000
Other 3341 6765.250000 79467.3900 0.0000
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Total 6585 18399.000000 170565.0900 77957.9900