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:OTHER
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 154 284.000000 10564.8000 37.2000
Subtotal (Total Children Is Unduplicated) 154 284.000000 10564.8000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 12 14.500000 1087.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 7.000000 525.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 14 17.000000 943.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 59 83.500000 6262.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 86 129.000000 9675.0000 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 106 138.000000 7659.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 11 64.000000 3386.5500 52.9148
Subtotal (Total Children Is Unduplicated) 177 469.000000 30715.4600 65.4914
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 27 44.000000 2200.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 2 2.000000 100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 25 30.000000 750.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 5.000000 250.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 5.000000 250.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 5.000000 250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 6 3.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 308 1665.000000 83250.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 10.000000 500.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 200 708.000000 7080.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 74 302.500000 21767.9000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 62 216.000000 15543.3600 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 13.000000 935.4800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 137 605.000000 43535.8000 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 4.000000 287.8400 71.9600
TRAV-TRAVS-Travel by mile 579 28653.00000 12623.8500 0.4406
Subtotal (Total Children Is Unduplicated) 781 32277.50000 189649.2300 5.8756
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Total 33030.500000 230929.4900 6.9914
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Number of Children (Unduplicated) With at Least One Service 958
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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 662 10030.750000 88500.3900 88500.3900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 360 462.500000 25951.0500 0.0000
T 1246 22399.000000 111048.1300 111048.1300
98 132.250000 4979.9200 0.0000
Other 3 6.000000 450.0000 0.0000
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Total 2369 33030.500000 230929.4900 199548.5200