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
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
EXIT-EXIT-COS Exit 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 31.500000 2362.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 25.000000 1875.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 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
Subtotal (Total Children Is Unduplicated) 43 86.500000 6095.7600 70.4712
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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
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 169 687.500000 34375.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 13.000000 650.0000 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 6 18.000000 1295.2800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 5.000000 359.8000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 20 53.000000 3813.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 112.750000 7793.6100 69.1229
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
TRAV-TRAVS-Travel by mile 471 42441.00000 18878.7300 0.4448
Subtotal (Total Children Is Unduplicated) 628 46287.75000 122990.7600 2.6571
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Total 46374.250000 129086.5200 2.7836
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Number of Children (Unduplicated) With at Least One Service 651
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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 849 6180.500000 17864.3800 17864.3800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 18 238.000000 484.1200 484.1200
T 0 0.000000 0.0000 0.0000
5186 39955.750000 110738.0200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6053 46374.250000 129086.5200 18348.5000