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:EIP DEI DEIP
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 3 5.500000 305.2500 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 75 144.500000 10837.5000 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 132 256.000000 14286.0000 55.8047
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) 278 1042.500000 71248.6400 68.3440
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EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 2 3.000000 150.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 27.000000 1942.9200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 13.000000 935.4800 71.9600
Subtotal (Total Children Is Unduplicated) 8 43.000000 3028.4000 70.4279
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Total 7326.500000 306126.0400 41.7834
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Number of Children (Unduplicated) With at Least One Service 1948
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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 0 0.000000 0.0000 0.0000
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
9481 7047.000000 295737.9400 0.0000
Other 473 279.250000 10378.8000 0.0000
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Total 9955 7326.500000 306126.0400 0.0000