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
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 1575 1510.500000 56164.7000 37.1829
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 95 101.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 576 1138.250000 42342.9000 37.2000
Subtotal (Total Children Is Unduplicated) 1667 2749.750000 98507.6000 35.8242
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 9 9.000000 125.8300 13.9811
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 8.000000 57.6000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.000000 202.4400 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 55.2400 13.8100
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 1 1.000000 75.1300 75.1300
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 28.9900 28.9900
EXIT-EXIT-EXIT ASSESSMENT 4 4.750000 237.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 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 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 22.000000 1515.0000 68.8636
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 16.000000 1200.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 97.500000 5411.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 24 48.000000 2664.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 32.000000 2400.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 14.950600 1121.2950 75.0000
OCTH-97166-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 3 3.000000 140.1200 46.7067
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 120 303.200600 17351.3450 57.2273
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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 341 1634.500000 81680.0000 49.9725
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 55 145.000000 7250.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1355 8124.000000 81585.0000 10.0425
OCCT-97530-OT SESSION BY LICENSED OT 12 52.000000 3688.3300 70.9294
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.250000 89.9500 71.9600
PHY-97110-PT SESSION BY LICENSED PT 14 37.000000 2468.4400 66.7146
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 8.2100 8.2100
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 1 2.000000 12.0300 6.0150
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 148.500000 9467.9800 63.7574
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 11.000000 791.5600 71.9600
TRAV-TRAVS-Travel by mile 7 414.000000 184.1600 0.4448
Subtotal (Total Children Is Unduplicated) 1443 11745.25000 240081.8800 20.4408
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Total 14798.200600 355940.8250 24.0530
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Number of Children (Unduplicated) With at Least One Service 2234
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Center 07
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 4525 11730.750000 244051.9300 244051.9300
D 2 1.500000 55.8000 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
5979 3060.950600 111647.0950 0.0000
Other 12 5.000000 186.0000 0.0000
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Total 10518 14798.200600 355940.8250 244051.9300