CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 Page: 1
List order: No List
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 1575 1510.500000 56164.7000 37.1829
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 95 101.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1570 2978.250000 110790.9000 37.2000
Subtotal (Total Children Is Unduplicated) 1826 4589.750000 166955.6000 36.3758
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 14 14.000000 199.2300 14.2307
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 16 16.000000 115.2000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 12.000000 347.0400 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 7 7.000000 96.6700 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 21.0400 21.0400
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 1 1.000000 75.1300 75.1300
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 2.000000 56.9900 28.4950
EXIT-EXIT-EXIT ASSESSMENT 4 4.750000 237.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 311.6700 51.9450
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 69 138.000000 10215.0000 74.0217
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 28 56.000000 4200.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 60 120.000000 9000.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 16 32.000000 2400.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 109 217.500000 12071.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 53 106.000000 5883.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 88.000000 6600.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 38.000000 2849.9950 74.9999
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 308.4600 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 6 6.000000 294.3500 49.0583
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 15 15.000000 771.1500 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 12.000000 584.3100 48.6925
Subtotal (Total Children Is Unduplicated) 335 969.250000 61076.4050 63.0141
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 49 47.000000 2350.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 71 84.000000 4050.0000 48.2143
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 16 14.500000 362.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 221 290.000000 14500.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 89 149.500000 7450.0000 49.8328
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 117 146.500000 7325.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 48 56.000000 2800.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 6 6.000000 150.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 33 33.250000 1662.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 34 39.750000 1987.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 107 126.750000 6337.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 32 34.500000 1725.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 4.000000 100.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 78 106.750000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 4 11.000000 550.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 360 1706.500000 85280.0000 49.9736
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 59 156.500000 7825.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1355 8126.000000 81605.0000 10.0425
OCCT-97530-OT SESSION BY LICENSED OT 39 155.750000 11154.1800 71.6159
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.750000 269.8500 71.9600
PHY-97110-PT SESSION BY LICENSED PT 38 140.000000 9880.3200 70.5737
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.750000 134.1400 48.7782
PHY-97110HM-PT SESSION BY PT ASST 1 23.000000 1323.8800 57.5600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 144.8400 144.8400
SENS-V5264-EARMOLD 2 3.000000 30.1600 10.0533
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 119 505.000000 35069.3400 69.4442
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 24.000000 1727.0400 71.9600
TRAV-TRAVS-Travel by mile 7 414.000000 184.1600 0.4448
Subtotal (Total Children Is Unduplicated) 1448 12412.25000 286015.4100 23.0430
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Total 17971.250000 514047.4150 28.6039
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Number of Children (Unduplicated) With at Least One Service 2294
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Center 07
Flag Claims Units Chgs Paid
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R 7 6.000000 223.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 845 722.250000 32492.1000 0.0000
P 6610 13916.299400 356471.5200 356350.6200
D 2 1.500000 55.8000 0.0000
S 1 0.500000 18.6000 0.0000
H 4 8.000000 600.0000 0.0000
T 0 0.000000 0.0000 0.0000
6041 3141.950600 117070.2950 0.0000
Other 315 174.750000 7115.9000 0.0000
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Total 13825 17971.250000 514047.4150 356350.6200