CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
EXIT-EXIT-COS Exit 27 22.000000 1100.0000 50.0000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 23.500000 1304.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 18 29.000000 1609.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 11.500000 862.5000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.4600 51.2300
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 7.000000 359.8700 51.4100
Subtotal (Total Children Is Unduplicated) 77 115.000000 6722.9900 58.4608
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 78 89.500000 4300.0000 48.0447
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 58 66.500000 3325.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 21 22.000000 600.0000 27.2727
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 98 158.500000 6225.0000 39.2744
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 84 153.750000 5237.5000 34.0650
CONIP-CONIP-CONSULT, ITDS PHONE 5 4.500000 112.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 38 38.000000 1900.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 36 40.750000 2037.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 22 22.000000 1100.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 26 28.000000 1400.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 83 109.000000 5450.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 22 23.000000 1150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 100.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 20 61.000000 3050.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 494 2108.750000 105218.5000 49.8961
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 46 124.000000 6200.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 108 308.000000 4620.0000 15.0000
INTR-T1013-INTERPRETER 92 218.500000 10701.0000 48.9748
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1435 7314.000000 87566.0000 11.9724
OCCT-97530-OT SESSION BY LICENSED OT 11 47.000000 3274.1800 69.6634
OCCT-97530GT-OT SESSION BY LICENSED OT 3 7.000000 503.7200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 52 169.500000 11668.0900 68.8383
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 76 293.500000 20827.8000 70.9635
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 9 42.000000 3022.3200 71.9600
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 9.000000 125.6400 13.9600
TRAV-TRAVS-Travel by mile 441 23089.00000 10223.7700 0.4428
Subtotal (Total Children Is Unduplicated) 1606 34549.75000 300010.4800 8.6834
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Total 34664.750000 306733.4700 8.8486
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Number of Children (Unduplicated) With at Least One Service 1632
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Center 01
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 1 1.500000 75.0000 75.0000
P 7631 21065.750000 177356.6600 177356.6600
D 242 496.250000 8144.4900 0.0000
S 1 2.000000 150.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5513 13097.250000 120983.3200 121107.7400
2 2.000000 24.0000 12.0000
Other 0 0.000000 0.0000 0.0000
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Total 13390 34664.750000 306733.4700 298551.4000