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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1099 1831.000000 67917.8500 37.0933
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 14 9.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1151 2446.750000 90749.3500 37.0898
Subtotal (Total Children Is Unduplicated) 1362 4287.500000 158667.2000 37.0069
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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 3 5.500000 412.5000 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 11 20.500000 1137.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.500000 637.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 79 139.500000 10462.5000 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 84 149.500000 11212.5000 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 40 64.500000 4837.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 170 286.000000 15873.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 48.500000 3637.5000 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) 287 770.500000 51301.2500 66.5818
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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 368 950.250000 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 466 1889.000000 28335.0000 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) 704 19403.75000 224078.5000 11.5482
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Total 24461.750000 434046.9500 17.7439
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Number of Children (Unduplicated) With at Least One Service 1489
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Center 53
Flag Claims Units Chgs Paid
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R 80 64.750000 3757.9500 0.0000
U 0 0.000000 0.0000 0.0000
B 736 671.250000 34949.1800 0.0000
P 2230 2056.500000 100720.0500 100704.4900
D 266 244.250000 12558.0500 0.0000
S 37 40.750000 2715.3700 0.0000
H 138 141.000000 10140.4400 0.0000
T 1492 9582.000000 26239.7100 26073.2100
10243 11455.500000 232082.6600 0.0000
Other 242 205.750000 10883.5400 0.0000
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Total 15464 24461.750000 434046.9500 126777.7000