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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 62 19.500000 725.4000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1946 3194.500000 118835.4000 37.2000
Subtotal (Total Children Is Unduplicated) 1954 3214.000000 119560.8000 37.2000
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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 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 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 7 15.000000 1125.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 6 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 18.500000 1026.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 11.500000 638.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 51.000000 3825.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 35 59.500000 4462.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 36.500000 2737.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 15.500000 1162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 31 56.500000 4237.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 28 44.000000 3300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 126 211.500000 11738.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 160 259.500000 14402.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 136 299.000000 22425.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 181 365.000000 27375.0000 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) 463 1494.750000 101849.4400 68.1381
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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 25 50.000000 1418.7500 28.3750
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 296 841.500000 40072.5000 47.6203
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 47 99.500000 4875.0000 48.9950
INTR-T1013-INTERPRETER 119 352.750000 13122.5000 37.2006
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 345 14844.00000 6567.8000 0.4425
Subtotal (Total Children Is Unduplicated) 1232 20842.75000 167975.7300 8.0592
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Total 25551.500000 389385.9700 15.2393
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Number of Children (Unduplicated) With at Least One Service 2411
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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 2483 8958.250000 53716.1100 53716.1100
D 239 946.500000 6446.0900 0.0000
S 4010 2951.000000 134931.3200 0.0000
H 258 308.750000 20973.7200 0.0000
T 3488 10389.250000 73723.4100 73374.7800
2202 1608.500000 73981.7700 60.0000
Other 270 389.250000 25613.5500 0.0000
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Total 12950 25551.500000 389385.9700 127150.8900