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
Payclass Filters:GR
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 5 10.000000 500.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 26 52.000000 3900.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 11 21.000000 1575.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 15 28.000000 2100.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 35.000000 1942.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 22.000000 1650.0000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 5 24.000000 1200.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 21 120.000000 6000.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 5.000000 264.6500 52.9300
Subtotal (Total Children Is Unduplicated) 102 333.500000 20307.0600 60.8907
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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 72 117.000000 5850.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 10 17.000000 850.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 80 105.000000 2625.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 7 7.000000 350.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 4 4.000000 200.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 12 12.000000 600.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 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 3 17.000000 850.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 288 1497.000000 74850.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 5.000000 250.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 59 337.000000 3370.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 30 123.000000 8636.5400 70.2158
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 49 261.000000 18781.5600 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 4 14.000000 1007.4400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 90 413.000000 29201.3500 70.7054
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 5.000000 359.8000 71.9600
TRAV-TRAVS-Travel by mile 1099 81992.00000 35999.8300 0.4391
Subtotal (Total Children Is Unduplicated) 1187 84960.50000 185327.4800 2.1813
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Total 85294.000000 205634.5400 2.4109
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Number of Children (Unduplicated) With at Least One Service 1246
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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 2540 63718.000000 156517.2800 156517.2800
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 253 10180.500000 24049.5900 24049.5900
427 11344.500000 21582.6700 0.0000
Other 26 51.000000 3485.0000 0.0000
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Total 3246 85294.000000 205634.5400 180566.8700