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
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 3 1.750000 81.2500 46.4286
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 12 22.000000 1221.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 12.000000 900.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.000000 1275.0000 75.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 7.000000 370.5100 52.9300
Subtotal (Total Children Is Unduplicated) 35 70.750000 4565.5100 64.5302
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 32 36.000000 1762.5000 48.9583
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 32 46.750000 2337.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 17 23.000000 375.0000 16.3043
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 23 45.000000 1318.7500 29.3056
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 6 28.000000 1237.5000 44.1964
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 56 163.000000 7010.0000 43.0061
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 14.000000 700.0000 50.0000
INTR-T1013-INTERPRETER 97 305.250000 11265.5000 36.9058
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 940 3486.000000 31850.0000 9.1365
PHY-97110-PT SESSION BY LICENSED PT 2 4.000000 287.8400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 47.000000 3191.3500 67.9011
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 8.000000 575.6800 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) 1079 19221.50000 76386.6500 3.9740
-----------------------------------------------------------------------------------------------------------------------
Total 19292.250000 80952.1600 4.1961
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1106
-----------------------------------------------------------------------------------------------------------------------
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 2155 8572.250000 34422.9100 34422.9100
D 156 862.000000 1943.7800 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2924 9809.000000 41337.4700 41427.4700
29 49.000000 3248.0000 60.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5264 19292.250000 80952.1600 75910.3800