CMS/EIP Fiscal Report Center: 09
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 1853 5746.750000 213751.2000 37.1951
TCM-T1017TL-TARGETED CASE MANAGEMENT 1933 7583.500000 281976.0000 37.1828
Subtotal (Total Children Is Unduplicated) 2095 13330.25000 495727.2000 37.1881
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 203 297.500000 14875.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 16 31.000000 2325.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 11 19.000000 1425.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 12.500000 898.5000 71.8800
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 26 45.000000 2497.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 231 423.500000 31733.2500 74.9309
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 157 280.000000 21000.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 96 180.000000 13500.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 325 583.500000 32384.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 96.000000 7200.0000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 5 28.000000 1400.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 22 154.000000 7700.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 10 10.000000 514.1000 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 4 4.000000 205.6400 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 308.4600 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 13 49.000000 2593.5700 52.9300
Subtotal (Total Children Is Unduplicated) 691 2233.500000 141435.4600 63.3246
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 5.000000 74.0000 14.8000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 80 137.000000 6850.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 27 56.500000 2825.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 112 146.500000 3662.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 9 9.000000 450.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 6 7.000000 350.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 13.000000 650.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 10.500000 525.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 22 23.000000 1150.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 4 4.000000 200.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 46 82.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 11 47.000000 2350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 998 6613.000000 330208.2300 49.9332
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 67 234.250000 11712.5000 50.0000
INTR-T1013-INTERPRETER 104 430.250000 21512.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 59 337.000000 3370.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 157 918.000000 65844.7400 71.7263
OCCT-97530GT-OT SESSION BY LICENSED OT 11 48.500000 3490.0600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 7 26.500000 1906.9400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 159 1249.000000 89818.1800 71.9121
PHY-97110GT-PT SESSION BY LICENSED PT 14 57.000000 4101.7200 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 5 8.000000 575.6800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 345 2254.000000 161607.7500 71.6982
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 53 184.500000 13276.6200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 26.000000 1799.0000 69.1923
TRAV-TRAVS-Travel by mile 1212 107940.0000 47479.5900 0.4399
Subtotal (Total Children Is Unduplicated) 1491 120871.7500 776011.9700 6.4201
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Total 136435.500000 1413174.6300 10.3578
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Number of Children (Unduplicated) With at Least One Service 2180
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Center 09
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 3374 3601.000000 141764.6000 211.0000
P 11495 92086.000000 647330.0800 647251.2900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 246 342.000000 19117.8000 0.0000
T 316 10710.250000 30708.2200 30708.2200
6544 29297.500000 545836.6800 0.0000
Other 206 398.750000 28417.2500 0.0000
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Total 22181 136435.500000 1413174.6300 678170.5100