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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 5 10.000000 500.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 10.000000 750.0000 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 3 6.000000 450.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 130 260.000000 19500.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 101 195.500000 14662.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 58 112.500000 8437.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 59 116.500000 6465.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 79.000000 5925.0000 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-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 14 111.000000 5874.2600 52.9213
Subtotal (Total Children Is Unduplicated) 336 984.500000 67081.6500 68.1378
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 86 151.500000 7525.0000 49.6700
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 10 15.000000 750.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 91 110.500000 2762.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 14 14.000000 700.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 15.000000 750.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 12.500000 625.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 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
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 5 20.000000 1000.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1148 8158.000000 407564.2400 49.9588
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 44 94.000000 4700.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 421 2227.000000 22220.0000 9.9775
OCCT-97530-OT SESSION BY LICENSED OT 147 949.000000 68290.0400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 11.000000 791.5600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 159 1119.000000 80462.7300 71.9059
PHY-97110GT-PT SESSION BY LICENSED PT 6 45.000000 3238.2000 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 296 2391.750000 172110.3300 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 33.000000 2374.6800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 16 47.000000 3382.1200 71.9600
TRAV-TRAVS-Travel by mile 1321 121204.0000 53229.1200 0.4392
Subtotal (Total Children Is Unduplicated) 1505 136638.0000 833531.9400 6.1003
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Total 137622.500000 900613.5900 6.5441
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Number of Children (Unduplicated) With at Least One Service 1674
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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 4807 104527.000000 420426.0900 420426.0900
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 1460 26692.500000 125367.4200 125367.4200
1812 6090.000000 332641.8300 0.0000
Other 158 313.000000 22178.2500 0.0000
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Total 8237 137622.500000 900613.5900 545793.5100