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
Payclass Filters:GR
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 848 2296.250000 85383.3000 37.1838
Subtotal (Total Children Is Unduplicated) 1414 2846.500000 105573.6000 37.0889
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 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 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 2.000000 102.8200 51.4100
Subtotal (Total Children Is Unduplicated) 15 53.000000 3494.7300 65.9383
-----------------------------------------------------------------------------------------------------------------------
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 59 59.250000 2925.0000 49.3671
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 24.000000 1125.0000 46.8750
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 336 2275.000000 110250.0000 48.4615
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 53 146.750000 7337.5000 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 5228.000000 62019.0000 11.8629
OCCT-97530-OT SESSION BY LICENSED OT 2 10.000000 719.6000 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 2 7.000000 403.2000 57.6000
PHY-97110HM-PT SESSION BY PT ASST 2 9.000000 356.1500 39.5722
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 2 6.250000 359.7500 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 43.750000 3148.2500 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 12.500000 899.5000 71.9600
Subtotal (Total Children Is Unduplicated) 998 9358.500000 222669.9500 23.7933
-----------------------------------------------------------------------------------------------------------------------
Total 12258.000000 331738.2800 27.0630
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1815
-----------------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 8138 8257.000000 194811.9400 194811.9400
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
5544 3736.250000 127086.9400 0.0000
Other 449 264.500000 9830.1000 0.0000
---------------------------------------------------------
Total 14132 12258.000000 331738.2800 194811.9400