CMS/EIP Fiscal Report Center: 10
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:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1211 3884.500000 144503.4000 37.2000
Subtotal (Total Children Is Unduplicated) 1211 3884.500000 144503.4000 37.2000
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 7 7.000000 136.5700 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 7 7.000000 102.7600 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 7.000000 50.4000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.000000 202.4400 28.9200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 7 7.000000 147.2800 21.0400
EXIT-EXIT-EXIT ASSESSMENT 2 3.500000 175.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 30.500000 2287.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 29 56.500000 4237.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 15.000000 1125.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 15.500000 1162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 43.500000 2386.5000 54.8621
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 37 70.500000 3912.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 10.500000 787.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.500000 337.5000 75.0000
NURS-T1001-NURSING ASSESSMENT 1 2.000000 100.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 5 5.000000 257.0500 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 8 13.000000 668.3300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
Subtotal (Total Children Is Unduplicated) 96 326.000000 19418.2000 59.5650
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 20.000000 8279.7000 413.9850
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 36 33.000000 1650.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 266 237.250000 11862.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 25 22.250000 556.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 62 81.750000 4087.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 171 216.500000 10825.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 3.750000 93.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 33 67.000000 3350.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 84 127.000000 6350.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 30 38.000000 1900.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 118 168.000000 8400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.250000 6.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 21.000000 1050.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 349 2780.500000 139025.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 197 1153.500000 57675.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1253 12617.00000 126170.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 39 224.750000 16173.0100 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 5 25.000000 1202.1600 48.0864
PHY-97110-PT SESSION BY LICENSED PT 40 134.500000 9678.6200 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 2 4.500000 323.8200 71.9600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 2.000000 115.1200 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 131 730.000000 52275.8000 71.6107
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 25 111.500000 8023.5400 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 2 1.250000 46.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1547 18827.25000 469466.2300 24.9355
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Total 23037.750000 633387.8300 27.4935
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Number of Children (Unduplicated) With at Least One Service 2200
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Center 10
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 5854 18814.500000 470048.8600 470048.9400
D 13 15.750000 365.3200 0.0000
S 40 55.000000 1036.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5263 4148.500000 161788.1000 40.0000
Other 7 4.000000 148.8000 0.0000
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Total 11177 23037.750000 633387.8300 470088.9400