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
Payclass Filters:GR
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 2 4.500000 225.0000 50.0000
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.000000 142.2300 142.2300
Subtotal (Total Children Is Unduplicated) 3 5.500000 367.2300 66.7691
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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 103 86.500000 4043.7500 46.7486
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 37 31.750000 1475.0000 46.4567
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 97 82.500000 1937.5000 23.4848
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 369 2381.500000 118275.0000 49.6641
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 53 160.000000 8000.0000 50.0000
INTR-T1013-INTERPRETER 8 47.500000 3120.0000 65.6842
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1117 7742.000000 77150.0000 9.9651
OCCT-97530HM-OT SESSION BY OT ASST 2 5.500000 316.8000 57.6000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 3.000000 172.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 3 19.750000 1403.1900 71.0476
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 4.000000 230.2400 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 42.750000 3075.1500 71.9333
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 287.8400 71.9600
TRAV-TRAVS-Travel by mile 1 20.000000 8.9000 0.4450
Subtotal (Total Children Is Unduplicated) 1174 10734.25000 223362.1300 20.8084
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Total 10739.750000 223729.3600 20.8319
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Number of Children (Unduplicated) With at Least One Service 1175
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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 7920 7885.500000 164742.7700 164742.7700
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
2850 2854.250000 58986.5900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10770 10739.750000 223729.3600 164742.7700