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
Payclass Filters:GR
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 1 1.000000 48.5000 48.5000
EXIT-EXIT-COS Exit 27 22.000000 1100.0000 50.0000
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 4 8.000000 444.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 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 1 4.000000 205.6400 51.4100
Subtotal (Total Children Is Unduplicated) 39 45.000000 2495.3000 55.4511
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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 7 21.000000 1050.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 117 405.500000 20275.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 20.500000 1025.0000 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 2 9.000000 647.6400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 14 43.000000 2644.7300 61.5053
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 45.250000 3151.7200 69.6513
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 18.000000 1295.2800 71.9600
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 5.000000 69.8000 13.9600
TRAV-TRAVS-Travel by mile 441 23089.00000 10223.7700 0.4428
Subtotal (Total Children Is Unduplicated) 1591 32254.25000 176207.4400 5.4631
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Total 32299.250000 178702.7400 5.5327
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Number of Children (Unduplicated) With at Least One Service 1599
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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 6293 19711.000000 103105.7600 103105.7600
D 142 396.500000 2872.5100 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4609 12188.250000 72625.4700 72625.4700
2 2.000000 24.0000 12.0000
Other 0 0.000000 0.0000 0.0000
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Total 11047 32299.250000 178702.7400 175818.2300