CMS/EIP Fiscal Report Center: 06
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:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 977 554.750000 20636.7000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 2.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 804 2348.500000 87317.7000 37.1802
Subtotal (Total Children Is Unduplicated) 1375 2905.250000 107954.4000 37.1584
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 4.000000 150.0000 37.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 11.500000 862.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 12.500000 937.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 12 22.000000 1221.0000 55.5000
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 23 61.000000 3830.8700 62.8011
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 98 82.750000 3950.0000 47.7341
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 22 18.000000 900.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 103 80.250000 1993.7500 24.8442
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 12 14.500000 725.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 10 11.500000 550.0000 47.8261
CONIP-CONIP-CONSULT, ITDS PHONE 15 16.000000 387.5000 24.2188
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 6.000000 300.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 7 12.500000 600.0000 48.0000
CONOP-CONOP-CONSULT, OT, PHONE 8 8.500000 212.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 5.500000 231.2500 42.0455
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 3 3.500000 175.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 3.500000 87.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 3.500000 125.0000 35.7143
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 4.500000 112.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 5 9.000000 450.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 355 2286.750000 114117.5000 49.9038
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 45 139.250000 6962.5000 50.0000
INTR-T1013-INTERPRETER 1 20.500000 1556.0100 75.9029
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1094 7202.000000 71570.0000 9.9375
OCCT-97530-OT SESSION BY LICENSED OT 1 5.000000 359.8000 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 0.500000 28.8000 57.6000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 3.000000 172.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 1 5.250000 377.7900 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 2 1.250000 89.9500 71.9600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 2.000000 115.1200 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 91.000000 6548.3600 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 12.250000 819.0300 66.8596
Subtotal (Total Children Is Unduplicated) 1160 10049.25000 213567.6600 21.2521
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Total 13015.500000 325352.9300 24.9973
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Number of Children (Unduplicated) With at Least One Service 1804
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Center 06
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 7675 7608.000000 158618.7000 158618.7000
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
7099 5239.500000 159593.4100 0.0000
Other 261 168.000000 7140.8200 0.0000
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Total 15035 13015.500000 325352.9300 158618.7000