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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 14 30.000000 1500.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 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 4 7.500000 416.2500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 40 79.500000 5962.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 78 151.500000 11362.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 43 81.000000 6075.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 84 155.000000 8602.5000 55.5000
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
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
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 23 125.000000 6426.2500 51.4100
Subtotal (Total Children Is Unduplicated) 271 777.500000 48918.6900 62.9179
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 65 107.750000 5387.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 35 54.000000 2700.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 95 128.500000 3237.5000 25.1946
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 11 11.000000 550.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 6 7.000000 350.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 17.000000 850.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 3 3.000000 150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 13.000000 650.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 11.000000 550.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 5 5.000000 250.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 7.000000 350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1131 6950.000000 347252.0000 49.9643
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 56 115.000000 5750.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 726 5021.000000 30993.1000 6.1727
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 400 2327.000000 28488.0000 12.2424
OCCT-97530-OT SESSION BY LICENSED OT 128 678.000000 48644.9600 71.7477
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 238 1751.000000 125225.1200 71.5163
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 38 184.000000 13240.6400 71.9600
TRAV-TRAVS-Travel by mile 1314 110600.0000 49079.7900 0.4438
Subtotal (Total Children Is Unduplicated) 1438 129169.2500 748037.0300 5.7911
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Total 129946.750000 796955.7200 6.1329
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Number of Children (Unduplicated) With at Least One Service 1579
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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 6616 115675.250000 482020.8400 482008.8800
D 159 1510.000000 6831.7400 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
1900 12576.000000 295771.3900 0.0000
Other 98 185.500000 12331.7500 0.0000
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Total 8773 129946.750000 796955.7200 482008.8800