CMS/EIP Fiscal Report Center: 57
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 692 668.000000 24849.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1492 6283.500000 233746.2000 37.2000
Subtotal (Total Children Is Unduplicated) 1532 6951.500000 258595.8000 37.2000
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Screening, Eval, and Assessment,Class #02
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 2 2.000000 27.6000 13.8000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 39.0200 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 29.3600 14.6800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 57.8400 28.9200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 42.0800 21.0400
EXIT-EXIT-EXIT ASSESSMENT 9 19.500000 975.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 22 41.000000 3075.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.000000 225.0000 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 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 29 54.000000 2997.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 228 416.500000 30935.9400 74.2760
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 67 121.000000 9030.1500 74.6293
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 46 78.000000 5850.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 313 583.000000 32206.5000 55.2427
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 30 53.000000 3975.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 6 6.000000 308.4600 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 12 12.000000 616.9200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 154.2300 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 41 41.000001 2107.8100 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 20 21.000000 1079.6100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 3.000000 158.7900 52.9300
Subtotal (Total Children Is Unduplicated) 462 1489.000001 95479.0000 64.1229
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EI Services,Class #03
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 231.6200 231.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 73 75.000000 3750.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 57 57.000000 2850.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 11 11.000000 550.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 40 40.000000 2000.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 82 84.000000 4200.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 294.000000 7350.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 42.000000 2100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1067 7692.000000 384600.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 74 340.000000 17000.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1099 9089.000000 90890.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 55 352.750003 25383.8900 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 14 84.000000 4838.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 17 80.500000 5792.7800 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 3.000000 215.8800 71.9600
PHY-97110HM-PT SESSION BY PT ASST 11 49.500000 2849.2200 57.5600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 459.2200 459.2200
SENS-V5264-EARMOLD 1 1.000000 18.1300 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 106 674.500003 48537.0200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 25.000000 1799.0000 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.000000 172.8000 57.6000
TRAV-TRAVS-Travel by mile 7 2648.000000 1178.3500 0.4450
Subtotal (Total Children Is Unduplicated) 1156 21654.25001 607066.3100 28.0345
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Total 30094.750007 961141.1100 31.9372
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Number of Children (Unduplicated) With at Least One Service 1710
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Center 57
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 2289 3280.500000 137346.9000 251.1000
P 1083 1587.663243 71050.2600 70863.7500
D 2 4.000000 261.0000 0.0000
S 16 24.500000 1042.7100 1042.7100
H 13 13.000000 904.8700 904.8700
T 3862 15317.836764 286766.2000 286202.5600
4945 9605.750000 454953.7500 320736.9400
Other 211 261.500000 8815.4200 612.8200
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Total 12421 30094.750007 961141.1100 680614.7500