CMS/EIP Fiscal Report Center: 06
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 967 542.750000 20190.3000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7 7.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1908 5690.750000 211658.7000 37.1935
Subtotal (Total Children Is Unduplicated) 1945 6241.000000 231849.0000 37.1493
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 47 88.000000 6600.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 152 298.500000 22358.2500 74.9020
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 39 73.000000 5475.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 76 146.500000 10987.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 26.000000 1950.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 21 39.500000 2962.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 46 88.000000 4923.0000 55.9432
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 143 277.500000 15479.2500 55.7811
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 279 1068.000000 72702.8900 68.0739
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 69 63.750000 3175.0000 49.8039
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 60 60.250000 2975.0000 49.3776
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 82 51.750000 1268.7500 24.5169
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 6 6.750000 337.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 16 25.000000 1175.0000 47.0000
CONIP-CONIP-CONSULT, ITDS PHONE 11 10.250000 256.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 5.000000 250.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 11 21.000000 1000.0000 47.6190
CONOP-CONOP-CONSULT, OT, PHONE 3 3.500000 87.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 3.000000 150.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 0.750000 37.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 2.500000 62.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 903 6013.250000 297612.5000 49.4928
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 164 567.750000 28387.5000 50.0000
EPIC-99601-Early Steps Professional Development Fee 205 1227.000000 18315.0000 14.9267
INTR-T1013-INTERPRETER 23 139.250000 8099.5000 58.1652
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 763 5249.000000 62028.3500 11.8172
OCCT-97530-OT SESSION BY LICENSED OT 15 68.500000 4886.7500 71.3394
OCCT-97530GT-OT SESSION BY LICENSED OT 8 41.250000 2968.3500 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 11 41.750000 2363.0000 56.5988
OCCT-97530HMGT-OT SESSION BY OT ASST 8 23.250000 1310.3800 56.3604
PHY-97110-PT SESSION BY LICENSED PT 24 124.250000 8671.7900 69.7931
PHY-97110GT-PT SESSION BY LICENSED PT 3 6.250000 449.7500 71.9600
PHY-97110HM-PT SESSION BY PT ASST 14 55.500000 3025.1300 54.5068
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 8 19.250000 1108.0300 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 58 300.750000 21084.1800 70.1053
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 23 86.750000 6065.7000 69.9216
TRAV-TRAVS-Travel by mile 152 12634.00000 5627.1600 0.4454
Subtotal (Total Children Is Unduplicated) 1097 26853.75000 482865.5700 17.9813
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Total 34162.750000 787417.4600 23.0490
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Number of Children (Unduplicated) With at Least One Service 2089
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Center 06
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 8419 8490.250000 209716.3000 209716.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.250000 9.3000 0.0000
15899 25393.000000 567313.0600 0.0000
Other 473 279.250000 10378.8000 0.0000
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Total 24792 34162.750000 787417.4600 209716.3000