CMS/EIP Fiscal Report Center: 03
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
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 2.500000 93.0000 37.2000
Subtotal (Total Children Is Unduplicated) 1 2.500000 93.0000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 30.500000 2287.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 32 58.000000 4350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 21.500000 1612.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 2.500000 145.5000 58.2000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 39.500000 2192.2500 55.5000
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 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 2 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 3.000000 158.7900 52.9300
Subtotal (Total Children Is Unduplicated) 89 174.000000 12030.0000 69.1379
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 61 59.250000 2962.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 62 53.250000 2662.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 2 2.000000 100.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 16 20.000000 1000.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 5 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 19 25.750000 1287.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 5 4.750000 237.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 34 38.000000 1900.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 12 12.250000 612.5000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 13 16.000000 800.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 124 375.500000 18775.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 55 107.500000 5375.0000 50.0000
INTR-T1013-INTERPRETER 5 13.750000 645.0000 46.9091
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 433 1343.000000 13430.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 27.000000 1905.5600 70.5763
PHY-97110-PT SESSION BY LICENSED PT 14 40.250000 2822.1900 70.1165
PHY-97110GT-PT SESSION BY LICENSED PT 3 7.500000 539.7000 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 56.750000 3717.1500 65.5004
TRAV-TRAVS-Travel by mile 412 24772.00000 11020.9000 0.4449
Subtotal (Total Children Is Unduplicated) 529 26980.50000 70068.0000 2.5970
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Total 27157.000000 82191.0000 3.0265
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Number of Children (Unduplicated) With at Least One Service 593
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Center 03
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 2486 18407.000000 56747.9400 56747.9400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 72 468.000000 1533.8800 1533.8800
T 0 0.000000 0.0000 0.0000
1022 8282.000000 23909.1800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3580 27157.000000 82191.0000 58281.8200