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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 29 23.000000 855.6000 37.2000
Subtotal (Total Children Is Unduplicated) 29 23.000000 855.6000 37.2000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.000000 145.5000 48.5000
EXIT-EXIT-COS Exit 30 24.250000 1212.5000 50.0000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.000000 111.0000 55.5000
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 6 11.500000 862.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 25.000000 1875.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 39 58.500000 4387.5000 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 18 27.000000 2025.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 10 17.500000 1312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 165 260.500000 14457.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 74 119.500000 6632.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 178 341.000000 25575.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 124 228.000000 17100.0000 75.0000
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
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
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 22.000000 1151.5700 52.3441
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 510 1205.250000 81434.9900 67.5669
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 89 103.500000 5000.0000 48.3092
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 71 80.250000 4012.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 23 24.500000 662.5000 27.0408
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 108 173.500000 6975.0000 40.2017
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 85 154.750000 5287.5000 34.1680
CONIP-CONIP-CONSULT, ITDS PHONE 5 4.500000 112.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 48 50.750000 2537.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 46 52.750000 2637.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 9 6.500000 162.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 57 77.750000 3887.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 31 33.000000 1650.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 7.000000 175.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 105 139.250000 6962.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 25 28.000000 1400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 5.000000 175.0000 35.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 20 61.000000 3050.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 550 2308.750000 115218.5000 49.9051
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 63 141.750000 7087.5000 50.0000
EPIC-99601-Early Steps Professional Development Fee 108 308.000000 4620.0000 15.0000
INTR-T1013-INTERPRETER 103 240.000000 11743.5000 48.9313
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1437 7316.000000 87590.0000 11.9724
OCCT-97530-OT SESSION BY LICENSED OT 28 118.750000 8437.3100 71.0510
OCCT-97530GT-OT SESSION BY LICENSED OT 5 9.000000 647.6400 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 65 222.750000 15499.9600 69.5846
PHY-97110GT-PT SESSION BY LICENSED PT 4 4.000000 287.8400 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 89 350.500000 24929.5200 71.1256
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 48.000000 3454.0800 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
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 9.000000 125.6400 13.9600
TRAV-TRAVS-Travel by mile 450 23308.00000 10316.3700 0.4426
Subtotal (Total Children Is Unduplicated) 1721 35558.50000 347022.4800 9.7592
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Total 36786.750000 429313.0700 11.6703
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Number of Children (Unduplicated) With at Least One Service 2051
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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 7670 21275.750000 179795.8500 179795.8500
D 248 528.750000 8341.7500 0.0000
S 15 16.000000 1116.3400 0.0000
H 1003 1320.000000 88340.9600 57574.7200
T 5531 13145.750000 122498.7200 122623.1400
454 499.000000 29144.4500 12.0000
Other 0 0.000000 0.0000 0.0000
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Total 14922 36786.750000 429313.0700 360080.7100