CMS/EIP Fiscal Report Center: 54
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 761 566.750000 21083.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 75 58.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1447 4898.750000 182224.2000 37.1981
Subtotal (Total Children Is Unduplicated) 1490 5524.250000 203307.3000 36.8027
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 14 15.000000 727.5000 48.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 19.500000 1462.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 9.500000 712.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 18 35.000000 2625.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 21.500000 1612.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 71 137.500000 10312.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 25.500000 1912.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 28 54.000000 4050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 37 74.000000 4107.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 48.000000 3600.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 59 121.000000 9075.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 240 594.500000 42450.4100 71.4052
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 17 37.000000 2662.5200 71.9600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 29 25.250000 1262.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 101 99.500000 4975.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 9 4.750000 237.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 272 142.750000 7137.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 28 30.000000 1500.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 294 130.750000 6525.0000 49.9044
CONOP-CONOP-CONSULT, OT, PHONE 2 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 36 37.500000 1875.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 249 93.250000 4662.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 58 73.750000 3687.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 184 97.250000 4862.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 459 1428.500000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 111 387.750000 19387.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 91 251.000000 12550.0000 50.0000
INTR-T1013-INTERPRETER 1 3.250000 162.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 456 1750.000000 17500.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 56 171.000000 12305.1600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 24 47.750000 3436.0900 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 60 248.500000 17882.0600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 25 67.000000 4821.3200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 53 239.250000 17216.4300 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 10 14.500000 1043.4200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 48 210.000000 15111.6000 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 13 22.750000 1637.0900 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 39 153.250000 11027.8700 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 19.250000 1385.2300 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 35 128.750000 9264.8500 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 21 49.750000 3580.0100 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 22 26.750000 989.7500 37.0000
Subtotal (Total Children Is Unduplicated) 692 5994.500000 188807.1500 31.4967
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Total 12113.250000 434564.8600 35.8752
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Number of Children (Unduplicated) With at Least One Service 1527
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Center 54
Flag Claims Units Chgs Paid
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R 15 17.750000 805.4200 0.0000
U 0 0.000000 0.0000 0.0000
B 986 913.250000 45206.5200 109.1600
P 4330 3916.500000 180403.4300 180221.3200
D 234 196.500000 10635.4000 0.0000
S 0 0.000000 0.0000 0.0000
H 82 85.000000 5705.6900 0.0000
T 0 0.000000 0.0000 0.0000
9460 6871.250000 186881.0000 0.0000
Other 149 113.000000 4927.4000 329.9200
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Total 15256 12113.250000 434564.8600 180660.4000