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
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 1635 1656.500000 61640.4000 37.2112
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 121 133.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1598 3052.500000 113507.0500 37.1849
Subtotal (Total Children Is Unduplicated) 1920 4842.250000 175147.4500 36.1707
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 76 152.000000 11300.0000 74.3421
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 33 66.000000 4950.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 74 148.000000 11100.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 21 42.000000 3150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 116.000000 8700.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 20 40.000000 3000.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 116 232.000000 12787.2000 55.1172
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 75 150.000000 8325.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 65 130.000000 9663.3000 74.3331
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 20.000000 1500.0000 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
SCREEN-T1023-SCREENING 2 2.000000 200.0000 100.0000
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) 387 1210.000000 81436.1800 67.3026
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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
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 96 124.500000 0.0000 0.0000
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 473 2617.000000 39255.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1214 7032.000000 84526.0000 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 37 1090.000000 470.7100 0.4318
Subtotal (Total Children Is Unduplicated) 1540 15585.00000 377938.2900 24.2501
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Total 21637.250000 634521.9200 29.3254
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Number of Children (Unduplicated) With at Least One Service 2415
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Center 07
Flag Claims Units Chgs Paid
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R 59 38.750000 1478.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 746 642.500000 30023.3000 0.0000
P 13569 17533.197800 461143.5050 461100.3000
D 43 46.000000 2389.2000 0.0000
S 2 0.500000 18.6000 0.0000
H 10 20.000000 1500.0000 0.0000
T 0 0.000000 0.0000 0.0000
6259 3630.052200 138324.7150 0.0000
Other 385 -273.750000 -355.5000 -4680.0000
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Total 21073 21637.250000 634521.9200 456420.3000