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
Agency Filter:EXT
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
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 21.500000 1193.2500 55.5000
Subtotal (Total Children Is Unduplicated) 12 25.500000 1454.2500 57.0294
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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 58 57.250000 2825.0000 49.3450
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 52 273.750000 19141.2600 69.9224
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 20 73.750000 5130.2200 69.5623
TRAV-TRAVS-Travel by mile 152 12634.00000 5627.1600 0.4454
Subtotal (Total Children Is Unduplicated) 1090 26810.75000 479837.1700 17.8972
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Total 26836.250000 481291.4200 17.9344
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Number of Children (Unduplicated) With at Least One Service 1095
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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 0 0.000000 0.0000 0.0000
6418 18346.000000 271575.1200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 14837 26836.250000 481291.4200 209716.3000