CMS/EIP Fiscal Report Center: 05
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 1.500000 112.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 7.500000 416.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.000000 750.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 18 30.000000 2250.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 412.5000 68.7500
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 23 40.500000 3037.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 22.500000 1687.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 32 52.000000 3900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 37 66.500000 3690.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 31 53.000000 2941.5000 55.5000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 8 8.000000 411.2800 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 8 9.000000 411.3100 45.7011
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 167.0800 41.7700
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 88.2400 44.1200
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 318.5500 45.5071
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 31.9700 31.9700
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 19.000000 942.9300 49.6279
Subtotal (Total Children Is Unduplicated) 143 363.000000 23134.8400 63.7323
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 84 74.750000 3737.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 17 16.750000 837.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 13 12.500000 312.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 97 141.750000 7087.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 6 4.500000 225.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 13 5.500000 137.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 47 63.000000 3150.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 40 40.000000 2000.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 12.000000 600.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 8 8.250000 412.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 32 25.750000 1287.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 13 11.500000 575.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.500000 12.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 32 108.500000 5425.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 194 1012.500000 50625.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 5.500000 275.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 562 3642.000000 36420.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 29 153.250000 10053.4900 65.6019
PHY-97110-PT SESSION BY LICENSED PT 24 52.250000 2794.3700 53.4808
PHY-97110GT-PT SESSION BY LICENSED PT 4 14.000000 544.1000 38.8643
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 40 147.500000 9490.3900 64.3416
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 5.000000 318.9200 63.7840
TRAV-TRAVS-Travel by mile 499 54955.00000 24409.2700 0.4442
Subtotal (Total Children Is Unduplicated) 598 60513.00000 160749.2900 2.6564
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Total 60876.000000 183884.1300 3.0206
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Number of Children (Unduplicated) With at Least One Service 640
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Center 05
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 5629 59488.250000 176317.5600 176317.5600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
229 1387.750000 7566.5700 7566.8700
Other 0 0.000000 0.0000 0.0000
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Total 5858 60876.000000 183884.1300 183884.4300