CMS/EIP Fiscal Report Center: 53
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 1124 1906.500000 70670.5500 37.0682
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 13 11.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 548 855.250000 31703.6500 37.0695
Subtotal (Total Children Is Unduplicated) 1226 2772.750000 102374.2000 36.9215
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.000000 145.5000 48.5000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 1 2.000000 250.0000 125.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 15 27.000000 2025.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 8.000000 600.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 34.000000 1887.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 30 81.500000 5470.0000 67.1166
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.000000 287.8400 71.9600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 4.500000 225.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 21 18.000000 900.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 16 14.750000 737.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 147 120.250000 6012.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.250000 6.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 23.500000 1175.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 77 52.000000 2550.0000 49.0385
CONPF-CONPF-CONSULT, PT, FACE TO FACE 29 35.750000 1787.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 166 98.750000 4925.0000 49.8734
CONPP-CONPP-CONSULT, PT, PHONE 3 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 30 29.250000 1462.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 137 86.000000 4300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 2.750000 68.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 377 1176.750000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 22 78.500000 3925.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 9 9.750000 487.5000 50.0000
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 377 1801.000000 18010.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 14.000000 1007.4400 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 3 2.500000 179.9000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 3 2.500000 179.9000 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 2 3.000000 215.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 19.000000 1367.2400 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 143.9200 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 3 4.000000 287.8400 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 32 58.250000 2155.2500 37.0000
Subtotal (Total Children Is Unduplicated) 510 3666.250000 52672.8800 14.3670
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Total 6520.500000 160517.0800 24.6173
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Number of Children (Unduplicated) With at Least One Service 1358
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Center 53
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 0 0.000000 0.0000 0.0000
D 269 177.750000 7545.4200 0.0000
S 8 7.000000 40.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9516 6316.750000 152224.8600 0.0000
Other 24 19.000000 706.8000 0.0000
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Total 9817 6520.500000 160517.0800 0.0000