CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2023 ending 09/30/2023 Date of Report:10/10/2023 Page: 1
List order: No List
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 1003 1677.000000 62189.0500 37.0835
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 12 8.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1038 2014.000000 74734.7500 37.1076
Subtotal (Total Children Is Unduplicated) 1246 3699.250000 136923.8000 37.0139
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 14.6800 14.6800
EXIT-EXIT-COS Exit 3 5.000000 250.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 15.000000 832.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 45 82.000000 6150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 58 106.500000 7987.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 24 40.500000 3037.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 107 189.500000 10517.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 33.000000 2475.0000 75.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 4.000000 211.7200 52.9300
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 10.000000 514.1000 51.4100
Subtotal (Total Children Is Unduplicated) 188 522.500000 34690.2500 66.3928
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 2.250000 112.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 12 10.250000 512.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 13 10.750000 537.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 122 98.000000 4900.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 40 57.000000 2850.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 79 52.250000 2612.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 27 31.250000 1562.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 125 59.000000 2937.5000 49.7881
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 36 35.250000 1762.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 123 81.000000 4050.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.000000 50.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 367 949.750000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 339 1217.750000 60587.5000 49.7536
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 190 373.500000 18675.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 465 1888.000000 28320.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 164 459.000000 5508.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 61 222.000000 15975.1200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 20 32.000000 2302.7200 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 37 95.500000 6872.1800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 14 28.000000 2014.8800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 25 103.250000 7393.8900 71.6115
PHY-97110GT-PT SESSION BY LICENSED PT 8 7.250000 521.7100 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 51 272.500000 19609.1000 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 13 13.250000 953.4700 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 164.750000 11855.4100 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 22 37.000000 2662.5200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 50 122.500000 8815.1000 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 34 59.250000 4263.6300 71.9600
TRAV-TRAVS-Travel by mile 243 12916.00000 5745.7700 0.4449
Subtotal (Total Children Is Unduplicated) 703 19402.25000 224063.5000 11.5483
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Total 23624.000000 395677.5500 16.7490
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Number of Children (Unduplicated) With at Least One Service 1370
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Center 53
Flag Claims Units Chgs Paid
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R 67 51.000000 3019.6500 0.0000
U 0 0.000000 0.0000 0.0000
B 676 604.000000 31641.9800 0.0000
P 1934 1742.750000 86358.9000 86343.3400
D 254 227.750000 11580.8000 0.0000
S 35 38.500000 2574.9700 0.0000
H 138 141.000000 10140.4400 0.0000
T 1485 9573.500000 25767.9600 25656.9600
9724 11053.500000 214466.5100 0.0000
Other 229 192.000000 10126.3400 0.0000
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Total 14542 23624.000000 395677.5500 112000.3000