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
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
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
Subtotal (Total Children Is Unduplicated) 2 4.000000 222.0000 55.5000
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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 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 5 35.750000 2572.5700 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.500000 107.9400 71.9600
Subtotal (Total Children Is Unduplicated) 995 9337.500000 221202.7100 23.6897
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Total 9341.500000 221424.7100 23.7033
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Number of Children (Unduplicated) With at Least One Service 996
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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 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 0 0.000000 0.0000 0.0000
1092 1084.500000 26612.7700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9230 9341.500000 221424.7100 194811.9400