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
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 1.750000 81.2500 46.4286
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.000000 333.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 16.500000 1237.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 22.000000 1650.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 6.500000 487.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 30.500000 1692.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 68 113.500000 6299.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 35 66.500000 4987.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 59 104.000000 7800.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 10.000000 529.3000 52.9300
Subtotal (Total Children Is Unduplicated) 205 400.250000 26678.3700 66.6543
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 34 41.000000 1837.5000 44.8171
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 32 46.750000 2337.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 18 25.000000 393.7500 15.7500
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 24 49.000000 1368.7500 27.9337
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 28 43.000000 1400.0000 32.5581
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 15.000000 750.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 9 12.000000 600.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 12.000000 600.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 13 13.000000 650.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 30 42.000000 1600.0000 38.0952
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 35 44.000000 2200.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 17 77.000000 3137.5000 40.7468
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 251 720.250000 34010.0000 47.2197
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 26 54.500000 2625.0000 48.1651
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 5 15.000000 1079.4000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 35 107.500000 7735.7000 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 54 190.000000 13481.6300 70.9559
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 29.000000 2032.8700 70.0990
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) 1093 20166.75000 127946.0100 6.3444
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Total 20567.000000 154624.3800 7.5181
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Number of Children (Unduplicated) With at Least One Service 1245
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Center 01
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 2451 8892.250000 51468.3800 51468.3800
D 239 946.500000 6446.0900 0.0000
S 8 15.500000 1084.5000 0.0000
H 1 1.500000 83.2500 0.0000
T 3480 10378.750000 73118.1600 72769.5300
32 54.000000 3623.0000 60.0000
Other 162 278.500000 18801.0000 0.0000
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Total 6373 20567.000000 154624.3800 124297.9100