CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 Page: 1
List order: No List
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 1050 1697.250000 62988.9000 37.1123
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 38 38.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1040 2132.000000 79273.1000 37.1825
Subtotal (Total Children Is Unduplicated) 1266 3867.250000 142262.0000 36.7863
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 13.8000 13.8000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.2000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 57.8400 28.9200
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.500000 637.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 8.000000 444.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.000000 825.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 68 128.000000 9600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 57 108.500000 8137.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 17.000000 1275.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 39 69.000000 5175.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 51.500000 2858.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 137 258.000000 14319.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.500000 1012.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 41.000000 3012.5000 73.4756
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.9300 52.9300
Subtotal (Total Children Is Unduplicated) 226 761.500000 50288.5200 66.0388
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 71.9600 71.9600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 17 19.000000 950.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 23 19.750000 987.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 17 13.500000 675.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 161 133.500000 6662.5000 49.9064
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 45 53.250000 2662.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 81 63.750000 3187.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 34 50.000000 2500.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 118 66.500000 3325.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 26 23.750000 1187.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 173 116.750000 5837.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 3.250000 81.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 369 1231.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 394 1684.250000 84212.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 245 577.250000 28862.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 599 2697.000000 26970.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 33 160.750000 11567.5700 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 9 16.000000 1151.3600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 37 103.500000 7447.8600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 23 38.000000 2734.4800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 21 91.250000 6566.3500 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 5 11.000000 791.5600 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 44 224.250000 16137.0300 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 10 9.500000 683.6200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 54 185.750000 13366.5700 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 30 42.750000 3076.2900 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 37 115.500000 8311.3800 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 21 46.750000 3364.1300 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 39 40.250000 1489.2500 37.0000
TRAV-TRAVS-Travel by mile 283 18841.00000 8381.9400 0.4449
Subtotal (Total Children Is Unduplicated) 719 26682.50000 253305.1000 9.4933
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Total 31311.250000 445855.6200 14.2395
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Number of Children (Unduplicated) With at Least One Service 1383
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Center 53
Flag Claims Units Chgs Paid
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R 6 5.250000 246.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 519 488.000000 25917.9300 0.0000
P 2286 2137.750000 107974.1300 107923.1900
D 265 193.750000 9640.9300 0.0000
S 209 159.250000 6072.6000 0.0000
H 42 42.000000 2821.6300 0.0000
T 1312 11432.500000 17440.2000 17440.2000
11552 16676.500000 268209.0600 0.0000
Other 215 176.250000 7532.6400 0.0000
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Total 16406 31311.250000 445855.6200 125363.3900