CMS/EIP Fiscal Report Center: 07
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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 3 2.250000 83.7000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 4 6.750000 251.1000 37.2000
Subtotal (Total Children Is Unduplicated) 4 9.000000 334.8000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 16.000000 1100.0000 68.7500
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 20.000000 1110.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 15 30.000000 1665.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 154.2300 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 21 21.000000 1079.6100 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 3 11.000000 565.5100 51.4100
Subtotal (Total Children Is Unduplicated) 76 138.000000 8103.6800 58.7223
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1257.6000 1257.6000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 56 52.250000 2612.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 86 92.250000 4612.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 8.500000 212.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 221 305.750000 15287.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 118 208.750000 10437.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 140 183.250000 9162.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 67 81.250000 4062.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 32 32.500000 1625.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 30 34.500000 1725.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 127 148.500000 7425.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 46 62.750000 3137.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 15.000000 375.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 450 2318.250000 115912.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 56 121.750000 6087.5000 50.0000
EPIC-99601-Early Steps Professional Development Fee 467 2611.000000 39165.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1197 7013.000000 84298.0000 12.0202
OCCT-97530-OT SESSION BY LICENSED OT 62 239.750000 15573.4000 64.9568
OCCT-97530GT-OT SESSION BY LICENSED OT 1 7.000000 503.7200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 40 154.500000 10144.7000 65.6615
PHY-97110GT-PT SESSION BY LICENSED PT 7 11.500000 665.7400 57.8904
PHY-97110HM-PT SESSION BY PT ASST 1 16.000000 920.9600 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 112 551.500000 37566.1400 68.1163
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 12.000000 863.5200 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 17.000000 979.2000 57.6000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 4 41.000000 2361.6000 57.6000
TRAV-TRAVS-Travel by mile 32 1039.000000 448.0200 0.4312
Subtotal (Total Children Is Unduplicated) 1457 15384.50000 377597.6000 24.5440
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Total 15531.500000 386036.0800 24.8550
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Number of Children (Unduplicated) With at Least One Service 1467
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Center 07
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 11717 15911.500000 390369.2800 390375.2800
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
9 9.000000 334.8000 0.0000
Other 142 -389.000000 -4668.0000 -4668.0000
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Total 11868 15531.500000 386036.0800 385707.2800