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
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
EXIT-EXIT-EXIT ASSESSMENT 3 6.000000 300.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 14 22.500000 1602.5000 71.2222
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 15.000000 1125.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 7.500000 416.2500 55.5000
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 3 3.000000 334.5600 111.5200
Subtotal (Total Children Is Unduplicated) 23 63.000000 4424.0600 70.2232
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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 104 87.500000 4093.7500 46.7857
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 37 31.750000 1475.0000 46.4567
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 98 83.000000 1950.0000 23.4940
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 59 302.000000 20551.0500 68.0498
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 50 177.500000 12153.6000 68.4710
TRAV-TRAVS-Travel by mile 543 21768.00000 9696.7100 0.4455
Subtotal (Total Children Is Unduplicated) 1265 38375.50000 541749.3500 14.1171
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Total 38438.500000 546173.4100 14.2090
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Number of Children (Unduplicated) With at Least One Service 1274
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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
11190 30400.750000 372196.6800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 19333 38438.500000 546173.4100 173976.7300