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
Payclass Filters:GR
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 647 1083.500000 40306.2000 37.2000
Subtotal (Total Children Is Unduplicated) 694 1103.000000 41031.6000 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 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-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 11.000000 825.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.500000 487.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 23.500000 1304.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 23 38.500000 2136.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 38.500000 2887.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 47.000000 3525.0000 75.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 7.000000 370.5100 52.9300
Subtotal (Total Children Is Unduplicated) 74 200.250000 13513.2600 67.4819
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 47 49.750000 2450.0000 49.2462
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 40 55.500000 2775.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 23 28.000000 500.0000 17.8571
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 24 46.000000 1368.7500 29.7554
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 41 54.000000 2200.0000 40.7407
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 6 28.000000 1237.5000 44.1964
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 57 163.750000 7047.5000 43.0382
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 14.000000 700.0000 50.0000
INTR-T1013-INTERPRETER 118 348.750000 12972.5000 37.1971
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 940 3486.000000 31850.0000 9.1365
OCCT-97530-OT SESSION BY LICENSED OT 3 13.750000 989.4500 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 5 13.000000 935.4800 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 1 4.000000 287.8400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 14 58.000000 3982.9100 68.6709
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 9.000000 647.6400 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) 1150 19419.50000 85769.7500 4.4167
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Total 20722.750000 140314.6100 6.7710
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Number of Children (Unduplicated) With at Least One Service 1593
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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 2185 8634.750000 36508.1400 36508.1400
D 156 862.000000 1943.7800 0.0000
S 17 7.750000 288.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 2926 9811.500000 41440.2200 41530.2200
2047 1406.000000 60106.2700 60.0000
Other 3 0.750000 27.9000 0.0000
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Total 7334 20722.750000 140314.6100 78098.3600