CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 Page: 1
List order: No List
Payclass Filters:GR
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 1582 1439.750000 53484.0000 37.1481
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 69 68.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 522 1037.500000 38510.3500 37.1184
Subtotal (Total Children Is Unduplicated) 1667 2545.500000 91994.3500 36.1400
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Screening, Eval, and Assessment,Class #02
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.2000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 28.9200 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 13.8100 13.8100
EXIT-EXIT-EXIT ASSESSMENT 2 2.500000 125.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.000000 775.0000 70.4545
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 52 103.500000 5744.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 28 58.000000 3219.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 32.000000 2400.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 15.500000 1112.5000 71.7742
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 26.4100 26.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 70.3200 35.1600
Subtotal (Total Children Is Unduplicated) 104 258.500000 15501.4600 59.9670
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 38 42.750000 2137.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 56 61.750000 3087.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 2.500000 62.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 190 261.500000 13075.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 104 137.250000 6862.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 101 111.750000 5587.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 60 63.250000 3162.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 37 44.500000 2225.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 28 40.250000 2012.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 95 106.750000 5337.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 40 44.000000 2200.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 7.000000 175.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 60 115.750000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 9 24.000000 1200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 320 1489.750000 74487.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 52 114.750000 5737.5000 50.0000
INTR-T1013-INTERPRETER 1 3.000000 154.5000 51.5000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1296 7590.000000 76795.0000 10.1179
OCCT-97530-OT SESSION BY LICENSED OT 12 30.000000 1863.3000 62.1100
PHY-97110-PT SESSION BY LICENSED PT 12 45.750000 3032.6700 66.2879
PHY-97110HM-PT SESSION BY PT ASST 1 9.000000 518.0400 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 47 204.000000 11938.6600 58.5228
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 2.750000 101.7500 37.0000
TRAV-TRAVS-Travel by mile 15 1103.000000 490.6600 0.4448
Subtotal (Total Children Is Unduplicated) 1379 11657.00000 222341.5400 19.0737
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Total 14461.000000 329837.3500 22.8088
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Number of Children (Unduplicated) With at Least One Service 2250
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Center 07
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 4238 11597.250000 225734.2500 225724.2500
D 7 4.250000 158.1000 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
5366 2857.500000 103870.6000 120.0000
Other 1 2.000000 74.4000 0.0000
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Total 9612 14461.000000 329837.3500 225844.2500