CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 Page: 1
List order: No List
Agency Filter:EXT
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 1 3.250000 120.9000 37.2000
Subtotal (Total Children Is Unduplicated) 1 3.250000 120.9000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.500000 637.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 66 130.000000 9450.0000 72.6923
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 28.000000 2100.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 56.000000 3108.0000 55.5000
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 17 17.000000 850.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 12.000000 171.9900 14.3325
Subtotal (Total Children Is Unduplicated) 117 269.500000 17447.9500 64.7419
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 17 16.000000 800.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 27 30.000000 1500.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 8.500000 212.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 26 53.750000 2687.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 26.750000 1337.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 21 78.000000 3900.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 5.500000 275.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 216 866.750000 43237.5000 49.8846
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 367 1840.000000 18400.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 13 42.500000 3058.3000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 8 23.000000 1324.8000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 16 73.500000 5289.0600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 9 39.000000 2246.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 30 84.500000 6080.6200 71.9600
PHY-97110HM-PT SESSION BY PT ASST 14 91.750000 5223.5700 56.9326
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 3 2.000000 115.1200 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 25 82.000000 5900.7200 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 8 38.750000 2230.4500 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 167.000000 11902.7700 71.2741
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 33 157.250000 11315.7100 71.9600
TRAV-TRAVS-Travel by mile 194 10839.00000 4822.5000 0.4449
Subtotal (Total Children Is Unduplicated) 385 14570.00000 132091.4400 9.0660
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Total 14842.750000 149660.2900 10.0831
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Number of Children (Unduplicated) With at Least One Service 439
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Center 52
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 0 0.000000 0.0000 0.0000
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 1900 13374.250000 62512.9400 62512.9400
742 1466.500000 87047.3500 0.0000
Other 1 2.000000 100.0000 100.0000
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Total 2643 14842.750000 149660.2900 62612.9400