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
Payclass Filters:GR
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 1951 5974.000000 222204.9000 37.1953
TCM-T1017TL-TARGETED CASE MANAGEMENT 887 3482.750000 129502.5000 37.1840
Subtotal (Total Children Is Unduplicated) 2069 9456.750000 351707.4000 37.1911
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 200 291.500000 14575.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.500000 562.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 412.5000 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 4 7.500000 416.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 51 97.000000 7275.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 23 43.000000 3225.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 30 55.000000 4125.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 65 121.000000 6715.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 28.500000 2137.5000 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
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 5.000000 264.6500 52.9300
Subtotal (Total Children Is Unduplicated) 333 819.000000 47827.0400 58.3969
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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 74 125.000000 6250.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 26 54.500000 2725.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 103 133.500000 3337.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 8 8.000000 400.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 5 6.000000 300.0000 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 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 80.500000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 4 18.000000 900.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 291 1500.000000 75000.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 19 61.000000 3050.0000 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 31 124.000000 8708.5000 70.2298
OCCT-97530GT-OT SESSION BY LICENSED OT 3 20.000000 1439.2000 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 10 36.500000 2626.5400 71.9600
TRAV-TRAVS-Travel by mile 1099 81992.00000 35999.8300 0.4391
Subtotal (Total Children Is Unduplicated) 1290 85688.75000 218133.4200 2.5456
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Total 95964.500000 617667.8600 6.4364
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Number of Children (Unduplicated) With at Least One Service 2220
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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 9288 70323.000000 411385.0700 411385.0700
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 285 10215.250000 25444.6900 25444.6900
4492 15363.250000 176453.1000 0.0000
Other 32 63.000000 4385.0000 0.0000
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Total 14097 95964.500000 617667.8600 436829.7600