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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 1049 1696.750000 62970.3000 37.1123
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 38 38.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 446 729.500000 27128.1000 37.1873
Subtotal (Total Children Is Unduplicated) 1140 2464.250000 90098.4000 36.5622
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 14 27.000000 2025.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 25 47.500000 2636.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
Subtotal (Total Children Is Unduplicated) 37 105.000000 6797.2500 64.7357
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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 1230.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 45 216.250000 10812.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 15 43.000000 2150.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 599 2697.000000 26970.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 45.500000 3274.1800 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 2 3.000000 215.8800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 1 7.000000 503.7200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 3 5.000000 359.8000 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.500000 35.9800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 14.000000 1007.4400 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 7.000000 503.7200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 4 12.000000 863.5200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 287.8400 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) 657 23734.25000 85190.4000 3.5893
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Total 26303.500000 182086.0500 6.9225
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Number of Children (Unduplicated) With at Least One Service 1321
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Center 53
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 201 137.000000 6204.1400 0.0000
S 71 55.500000 1309.7000 0.0000
H 0 0.000000 0.0000 0.0000
T 1307 11427.500000 17254.0800 17254.0800
9643 14665.750000 156545.6300 0.0000
Other 19 17.750000 772.5000 0.0000
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Total 11241 26303.500000 182086.0500 17254.0800