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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1012 565.250000 21027.3000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7 7.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 892 2486.250000 92451.3000 37.1850
Subtotal (Total Children Is Unduplicated) 1479 3059.000000 113478.6000 37.0966
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 16.500000 1237.5000 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 4 6.000000 333.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 20.500000 1137.7500 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) 19 64.000000 4212.4800 65.8200
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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 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 26 145.250000 8443.5000 58.1308
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) 1001 9364.500000 223013.9500 23.8148
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Total 12487.500000 340705.0300 27.2837
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Number of Children (Unduplicated) With at Least One Service 1882
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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 8141 8263.000000 195155.9400 195155.9400
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 2 2.500000 93.0000 0.0000
5775 3949.250000 135319.0900 0.0000
Other 456 272.750000 10137.0000 0.0000
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Total 14374 12487.500000 340705.0300 195155.9400