CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
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 1369 3103.750000 115459.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1459 4105.750000 152752.5000 37.2045
Subtotal (Total Children Is Unduplicated) 1700 7209.500000 268212.0000 37.2026
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 120 206.000000 10300.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 16.500000 1198.5000 72.6364
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 5.500000 412.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 9.500000 712.5000 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 1 1.000000 55.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 15 24.500000 1359.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 170 302.500000 22620.7500 74.7793
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 3.500000 262.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 164 286.000000 21450.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 90 164.500000 12412.5000 75.4559
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 10.000000 555.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 292 507.500000 28197.0000 55.5606
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 38.000000 2850.0000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 4 5.000000 250.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 15 86.000000 4300.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 123.3700 61.6850
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 5.000000 257.0500 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 23 125.000000 6426.2500 51.4100
Subtotal (Total Children Is Unduplicated) 555 1820.500000 115132.1800 63.2421
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 72 123.750000 6187.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 36 57.000000 2850.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 105 145.000000 3650.0000 25.1724
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 14 15.000000 750.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 6 7.000000 350.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 18.000000 900.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 3 3.000000 150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 14.000000 700.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 12.000000 600.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 5 5.000000 250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 37 85.000000 0.5000 0.0059
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 7.000000 350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1145 6964.000000 347952.0000 49.9644
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 90 200.500000 10025.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 726 5021.000000 30993.1000 6.1727
INTR-T1013-INTERPRETER 83 353.250000 17662.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 400 2327.000000 28488.0000 12.2424
OCCT-97530-OT SESSION BY LICENSED OT 131 684.000000 49076.7200 71.7496
OCCT-97530GT-OT SESSION BY LICENSED OT 4 9.750000 701.6100 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 3 8.000000 575.6800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 162 1166.000000 83402.9400 71.5291
PHY-97110GT-PT SESSION BY LICENSED PT 3 13.000000 935.4800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 241 1754.000000 125441.0000 71.5171
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 44 208.000000 14967.6800 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
TRAV-TRAVS-Travel by mile 1327 111055.0000 49282.2700 0.4438
Subtotal (Total Children Is Unduplicated) 1501 130258.2500 776410.9000 5.9606
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Total 139288.250000 1159755.0800 8.3263
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Number of Children (Unduplicated) With at Least One Service 2059
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Center 09
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 11674 121402.750000 688086.5700 688074.6100
D 159 1510.000000 6831.7400 0.0000
S 0 0.000000 0.0000 0.0000
H 2170 2443.750000 109136.9300 93717.6800
T 0 0.000000 0.0000 0.0000
2972 13742.500000 343096.2900 130.2000
Other 101 189.250000 12603.5500 0.0000
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Total 17076 139288.250000 1159755.0800 781922.4900