CMS/EIP Fiscal Report Center: 06
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 941 595.500000 22143.3000 37.1844
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 11 9.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1820 5774.500000 214736.2000 37.1870
Subtotal (Total Children Is Unduplicated) 1857 6379.500000 236879.5000 37.1314
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 3 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 5 7.500000 562.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 6.500000 487.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 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 4 6.500000 360.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 22.500000 1687.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 119 212.500000 15852.5000 74.6000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 27.500000 2062.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 110 196.500000 14737.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 73 138.500000 10387.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 46.500000 2580.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 197 367.000000 20368.5000 55.5000
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 3.000000 334.5600 111.5200
SPCH-92521-EVAL OF SPEECH FLUENCY 1 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 257.0500 51.4100
Subtotal (Total Children Is Unduplicated) 302 1071.500000 71708.8500 66.9238
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 209.7100 209.7100
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 107 92.000000 4318.7500 46.9429
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 38 33.750000 1575.0000 46.6667
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 99 83.500000 1962.5000 23.5030
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 12.000000 500.0000 41.6667
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 4 8.000000 400.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 20 28.000000 643.7500 22.9911
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 3.500000 175.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 3 6.500000 325.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 10 16.000000 350.0000 21.8750
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 5.000000 212.5000 42.5000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 0.500000 25.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 3.000000 150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 4.500000 112.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 10 13.000000 650.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1040 6874.500000 342845.0000 49.8720
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 180 563.000000 28150.0000 50.0000
INTR-T1013-INTERPRETER 8 47.500000 3120.0000 65.6842
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1117 7748.000000 77152.6700 9.9578
OCCT-97530-OT SESSION BY LICENSED OT 30 153.500000 10623.7300 69.2100
OCCT-97530GT-OT SESSION BY LICENSED OT 3 6.500000 424.5800 65.3200
OCCT-97530HM-OT SESSION BY OT ASST 17 87.750000 4058.5900 46.2517
OCCT-97530HMGT-OT SESSION BY OT ASST 5 11.500000 647.9800 56.3461
PHY-97110-PT SESSION BY LICENSED PT 34 160.500000 10829.2000 67.4717
PHY-97110GT-PT SESSION BY LICENSED PT 11 36.250000 2582.9700 71.2543
PHY-97110HM-PT SESSION BY PT ASST 23 102.000000 5787.9700 56.7448
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 12 31.250000 1740.5900 55.6989
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 68 348.000000 23840.6600 68.5076
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 52 179.750000 12315.5100 68.5147
TRAV-TRAVS-Travel by mile 543 21768.00000 9696.7100 0.4455
Subtotal (Total Children Is Unduplicated) 1270 38430.75000 545538.3700 14.1954
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Total 45881.750000 854126.7200 18.6158
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Number of Children (Unduplicated) With at Least One Service 1964
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Center 06
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 8143 8037.750000 173976.7300 173976.7300
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
21323 37660.500000 673149.5600 0.0000
Other 261 183.500000 7000.4300 0.0000
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Total 29727 45881.750000 854126.7200 173976.7300