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
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
EXIT-EXIT-EXIT ASSESSMENT 8 16.000000 800.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 12.000000 900.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 8.500000 598.5000 70.4118
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 6 11.500000 638.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 121 241.000000 18075.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 79 152.500000 11437.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 78 145.500000 10912.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 58 109.000000 6049.5000 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
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
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 13 49.000000 2593.5700 52.9300
Subtotal (Total Children Is Unduplicated) 361 1052.500000 70092.7000 66.5964
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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 78 129.000000 6450.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 11 19.000000 950.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 90 118.000000 2950.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 8 8.000000 400.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 5 5.000000 250.0000 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 6 6.500000 325.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 17.000000 850.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 3 3.000000 150.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 10 46.000000 2300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 994 6609.000000 330008.2300 49.9332
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 17 30.000000 1500.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 59 337.000000 3370.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 154 915.000000 65628.8600 71.7255
OCCT-97530GT-OT SESSION BY LICENSED OT 5 18.000000 1295.2800 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 344 2253.000000 161535.7900 71.6981
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 40 131.000000 9426.7600 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 1 3.000000 143.9200 47.9733
TRAV-TRAVS-Travel by mile 1212 107940.0000 47479.5900 0.4399
Subtotal (Total Children Is Unduplicated) 1394 119923.5000 730404.9700 6.0906
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Total 120976.000000 800497.6700 6.6170
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Number of Children (Unduplicated) With at Least One Service 1604
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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 0 0.000000 0.0000 0.0000
P 3984 84761.000000 362050.4900 362050.4900
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 284 10675.500000 29313.1200 29313.1200
2412 25142.000000 380763.3100 0.0000
Other 205 397.500000 28370.7500 0.0000
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Total 6885 120976.000000 800497.6700 391363.6100