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: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 1861 5880.000000 218560.5500 37.1702
TCM-T1017TL-TARGETED CASE MANAGEMENT 1911 7169.500000 266686.8000 37.1974
Subtotal (Total Children Is Unduplicated) 2108 13049.50000 485247.3500 37.1851
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 223 395.250000 19762.5000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 5.500000 412.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 5.500000 412.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 11 17.000000 943.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 122 208.500000 15637.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 104 168.000000 12600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 19 35.000000 2625.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 290 513.000000 28471.5000 55.5000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 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
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 4 4.000000 205.6400 51.4100
Subtotal (Total Children Is Unduplicated) 623 1364.750000 81841.5100 59.9681
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 3.000000 150.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 11 16.000000 800.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 27 27.250000 681.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 2.500000 125.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 5.000000 250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 55 123.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 3.000000 150.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 59 243.000000 12150.0000 50.0000
INTR-T1013-INTERPRETER 125 514.750000 25737.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 3.000000 215.8800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 18.000000 1295.2800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 4 20.000000 1439.2000 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 5.000000 359.8000 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 74.000000 5325.0400 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 5 29.000000 2086.8400 71.9600
Subtotal (Total Children Is Unduplicated) 231 1090.250000 50890.7900 46.6781
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Total 15504.500000 617979.6500 39.8581
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Number of Children (Unduplicated) With at Least One Service 2153
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Center 09
Flag Claims Units Chgs Paid
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R 186 182.500000 7056.0400 0.0000
U 0 0.000000 0.0000 0.0000
B 4120 4312.750000 174961.7800 0.0000
P 7481 7178.250000 277304.0700 277304.0700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 258 340.500000 19102.2000 0.0000
T 3068 3114.000000 120157.0300 120157.0300
256 360.000000 18607.9300 0.0000
Other 10 16.500000 790.6000 0.0000
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Total 15379 15504.500000 617979.6500 397461.1000