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:EIP DEI DEIP
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 195 281.500000 14075.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 19.000000 1425.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 13.000000 975.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 20 33.500000 1859.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 111 182.500000 13658.2500 74.8397
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 79 127.500000 9562.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 18 34.500000 2587.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 267 474.500000 26334.7500 55.5000
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 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
Subtotal (Total Children Is Unduplicated) 583 1181.000000 71342.7600 60.4088
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 8.000000 400.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 18 37.500000 1875.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 28 28.500000 712.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 6.000000 300.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 46 82.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 4.000000 200.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 50 204.250000 10212.5000 50.0000
INTR-T1013-INTERPRETER 104 430.250000 21512.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 3.000000 215.8800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 6 30.500000 2194.7800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 7 26.500000 1906.9400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 53.500000 3849.8600 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 23.000000 1655.0800 71.9600
Subtotal (Total Children Is Unduplicated) 218 948.250000 45607.0000 48.0960
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Total 15459.500000 612676.9600 39.6311
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Number of Children (Unduplicated) With at Least One Service 2116
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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 7511 7325.000000 285279.5900 285200.8000
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 32 34.750000 1395.1000 1395.1000
4132 4155.500000 165073.3700 0.0000
Other 1 1.250000 46.5000 0.0000
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Total 15296 15459.500000 612676.9600 286806.9000