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:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 26 18.750000 697.5000 37.2000
Subtotal (Total Children Is Unduplicated) 26 18.750000 697.5000 37.2000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-COS Exit 3 2.250000 112.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 18.000000 1350.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 32 49.000000 3675.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 19 27.500000 2062.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 16.500000 1237.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 15.500000 1162.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 112 179.000000 9934.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 37 62.000000 3441.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 118 235.500000 17662.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 92 170.500000 12787.5000 75.0000
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 15.000000 791.7000 52.7800
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 354 823.750000 56469.7500 68.5520
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 14.000000 700.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 13 13.750000 687.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 2.500000 62.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 15.000000 750.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 10 12.750000 637.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 10 12.000000 600.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 9 6.500000 162.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 35 55.750000 2787.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 5 5.000000 250.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 7.000000 175.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 22 30.250000 1512.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 3 5.000000 250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 56 200.000000 10000.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 17 17.750000 887.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 17 71.750000 5163.1300 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 22 70.000000 5037.2000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 5 16.000000 1151.3600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 13 53.250000 3831.8700 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 3.000000 215.8800 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 19 78.000000 5612.8800 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 2 2.000000 143.9200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 57.000000 4101.7200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 6.000000 431.7600 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 287.8400 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 143.9200 71.9600
Subtotal (Total Children Is Unduplicated) 210 766.250000 45852.9000 59.8407
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Total 1608.750000 103020.1500 64.0374
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Number of Children (Unduplicated) With at Least One Service 563
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 1 1.000000 50.0000 0.0000
S 14 14.000000 966.3400 0.0000
H 866 1127.000000 74967.7100 49656.9700
T 3 4.000000 216.5000 216.5000
425 462.750000 26819.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1309 1608.750000 103020.1500 49873.4700