CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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 58 18.250000 678.9000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1816 2893.000000 107619.6000 37.2000
Subtotal (Total Children Is Unduplicated) 1824 2911.250000 108298.5000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 2.000000 97.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 3 1.750000 81.2500 46.4286
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 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 11.000000 825.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 8.500000 637.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 14.000000 777.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 8.500000 471.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 43.000000 3225.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 26 45.500000 3412.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 30.500000 2287.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 14.000000 1050.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 53.000000 3975.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 20 32.500000 2437.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 99 169.000000 9379.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 116 194.500000 10794.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 111 251.500000 18862.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 129 265.500000 19912.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 10.000000 529.3000 52.9300
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.9300 52.9300
Subtotal (Total Children Is Unduplicated) 357 1177.750000 80316.9400 68.1952
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 49 54.750000 2525.0000 46.1187
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 40 55.500000 2775.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 24 30.000000 518.7500 17.2917
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 24 49.000000 1368.7500 27.9337
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 30 44.750000 1487.5000 33.2402
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 27 26.500000 1325.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 16 21.500000 1075.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 28 31.750000 1587.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 21 22.000000 1100.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 42 55.000000 2250.0000 40.9091
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 37 46.000000 2300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 4.000000 100.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 17 77.000000 3137.5000 40.7468
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 295 839.000000 39947.5000 47.6132
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 46 98.500000 4825.0000 48.9848
INTR-T1013-INTERPRETER 97 307.250000 11365.5000 36.9910
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 940 3486.000000 31850.0000 9.1365
OCCT-97530-OT SESSION BY LICENSED OT 23 79.750000 5738.8100 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 8 9.000000 647.6400 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 11 34.250000 2464.6300 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 5.000000 359.8000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 53 158.250000 11387.6700 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 3.000000 215.8800 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 20 67.000000 4821.3200 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 4 4.000000 287.8400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 71 279.000000 19886.0700 71.2762
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 9 34.000000 2392.6700 70.3726
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 4 12.000000 863.5200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 9.500000 683.6200 71.9600
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 1.000000 13.9600 13.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 1.000000 37.0000 37.0000
TRAV-TRAVS-Travel by mile 344 14830.00000 6561.5700 0.4425
Subtotal (Total Children Is Unduplicated) 1209 20778.75000 165987.5000 7.9883
-----------------------------------------------------------------------------------------------------------------------
Total 24867.750000 354602.9400 14.2596
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2277
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 2451 8892.250000 51468.3800 51468.3800
D 239 946.500000 6446.0900 0.0000
S 3722 2673.500000 121369.5700 0.0000
H 240 281.750000 19065.7200 0.0000
T 3480 10378.750000 73118.1600 72769.5300
1972 1394.500000 63458.9200 60.0000
Other 211 300.500000 19676.1000 0.0000
---------------------------------------------------------
Total 12315 24867.750000 354602.9400 124297.9100