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
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 223 395.250000 19762.5000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 18 35.000000 2625.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 17 31.000000 2325.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 43 83.500000 4634.2500 55.5000
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
Subtotal (Total Children Is Unduplicated) 292 561.750000 30503.8000 54.3014
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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 54 120.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 14 59.000000 2950.0000 50.0000
INTR-T1013-INTERPRETER 125 514.750000 25737.5000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 3 16.000000 1151.3600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 287.8400 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 54.000000 3885.8400 71.9600
Subtotal (Total Children Is Unduplicated) 214 827.250000 36243.7900 43.8124
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Total 10352.250000 400005.0400 38.6394
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Number of Children (Unduplicated) With at Least One Service 2027
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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 7478 7176.000000 277160.1500 277160.1500
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 3059 3107.500000 119957.0300 119957.0300
66 65.750000 2687.8600 0.0000
Other 2 3.000000 200.0000 0.0000
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Total 10605 10352.250000 400005.0400 397117.1800