CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 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 1861 5880.000000 218560.5500 37.1702
TCM-T1017TL-TARGETED CASE MANAGEMENT 817 3083.250000 114696.9000 37.2000
Subtotal (Total Children Is Unduplicated) 1969 8963.250000 333257.4500 37.1804
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 228 405.250000 20262.5000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 56 111.000000 8325.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 44 84.000000 6300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 30 58.000000 4350.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 59 115.500000 6410.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 25.000000 1875.0000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 4 11.000000 550.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 17 55.000000 2750.0000 50.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 3.000000 158.7900 52.9300
Subtotal (Total Children Is Unduplicated) 377 890.750000 52588.5900 59.0386
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 64 110.500000 5475.0000 49.5475
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 19 29.000000 1450.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 89 107.750000 2693.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 10.000000 500.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 13.000000 650.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 10.000000 500.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 12.750000 637.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 4 3.000000 150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 54 120.750000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 5 17.000000 850.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 369 1704.000000 85100.0000 49.9413
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 24 77.000000 3850.0000 50.0000
INTR-T1013-INTERPRETER 125 514.750000 25737.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 357 1519.000000 15140.0000 9.9671
OCCT-97530-OT SESSION BY LICENSED OT 38 150.000000 10794.0000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 16.000000 1151.3600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 26 132.750000 9552.6900 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 68 296.500000 21336.1400 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 9 58.000000 4173.6800 71.9600
TRAV-TRAVS-Travel by mile 1239 92551.00000 40605.2700 0.4387
Subtotal (Total Children Is Unduplicated) 1405 97455.75000 230471.8900 2.3649
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Total 107309.750000 616317.9300 5.7434
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Number of Children (Unduplicated) With at Least One Service 2140
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Center 09
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 11078 99824.500000 478021.8800 478021.8800
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 3277 7378.500000 132558.1900 132558.1900
66 65.750000 2687.8600 0.0000
Other 21 41.000000 3050.0000 0.0000
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Total 14442 107309.750000 616317.9300 610580.0700