CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 222 132.500000 4929.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 888 1690.750000 62895.9000 37.2000
Subtotal (Total Children Is Unduplicated) 957 1824.250000 67824.9000 37.1796
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 75.500000 5621.1300 74.4521
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 3.500000 262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 62.000000 4548.9400 73.3700
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 14.000000 1001.2400 71.5171
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 71 141.500000 7853.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 13.500000 749.2500 55.5000
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 5.000000 257.0500 51.4100
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 102.8200 51.4100
Subtotal (Total Children Is Unduplicated) 150 346.000000 22140.4600 63.9898
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 122 131.250000 6325.0000 48.1905
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 19 16.000000 800.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 5.000000 250.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 38 50.750000 2537.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 4 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 31 39.750000 1987.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 75 105.000000 5250.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 16 20.000000 1000.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 8 14.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 2.000000 100.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 189 738.250000 36912.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 9 16.000000 800.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 219 906.000000 13590.0000 15.0000
INTR-T1013-INTERPRETER 14 90.750000 4577.5000 50.4408
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 367 1583.000000 18985.0000 11.9931
OCCT-97530-OT SESSION BY LICENSED OT 7 23.750000 1709.0500 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 6.000000 431.7600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 33 96.750000 6560.1100 67.8048
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 166.750000 11172.8300 67.0035
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 143.9200 71.9600
TRAV-TRAVS-Travel by mile 471 42441.00000 18878.7300 0.4448
Subtotal (Total Children Is Unduplicated) 639 46461.00000 132361.4000 2.8489
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Total 48631.250000 222326.7600 4.5717
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Number of Children (Unduplicated) With at Least One Service 1148
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Center 03
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 865 6197.000000 18839.7200 18839.7200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 21 241.000000 634.1200 634.1200
T 0 0.000000 0.0000 0.0000
8301 42193.250000 202852.9200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9187 48631.250000 222326.7600 19473.8400