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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1952 5978.250000 222363.0000 37.1953
TCM-T1017TL-TARGETED CASE MANAGEMENT 2102 8017.750000 298130.1000 37.1838
Subtotal (Total Children Is Unduplicated) 2266 13996.00000 520493.1000 37.1887
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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 24 44.000000 3300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 13 22.500000 1687.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 14.000000 1011.0000 72.2143
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 35 59.000000 3274.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 321 570.500000 42729.0000 74.8975
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 209 365.500000 27412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 130 239.500000 17962.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 452 783.500000 43484.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 64 123.000000 9225.0000 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) 855 2788.500000 178858.2100 64.1414
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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 111 447.250000 22362.5000 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) 1498 120888.7500 776861.9700 6.4263
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Total 137673.250000 1476213.2800 10.7226
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Number of Children (Unduplicated) With at Least One Service 2352
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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 3507 3795.250000 150734.1500 211.0000
P 11808 92509.250000 666416.9800 666334.9400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 396 511.500000 28592.8500 0.0000
T 316 10710.250000 30708.2200 30708.2200
6765 29607.250000 561158.8300 0.0000
Other 280 539.750000 38602.2500 0.0000
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Total 23072 137673.250000 1476213.2800 697254.1600