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
Payclass Filters:GR
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 1 2.000000 111.0000 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 14 28.000000 2100.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 41 78.000000 5850.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 20.500000 1537.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 46 85.500000 4745.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.500000 1312.5000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 2.000000 100.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 10 38.000000 1900.0000 50.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 10 40.000000 2056.4000 51.4100
Subtotal (Total Children Is Unduplicated) 135 351.500000 21923.6500 62.3717
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 54 89.250000 4462.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 30 46.000000 2300.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 73 99.000000 2500.0000 25.2525
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 10.000000 500.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 3 3.000000 150.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 16 16.000000 800.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 3 3.000000 150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 9.000000 450.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 10.000000 500.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 5 5.000000 250.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 387 1921.000000 96050.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 10 19.000000 950.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 608 3634.000000 24138.1000 6.6423
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 358 1968.000000 24042.0000 12.2165
OCCT-97530-OT SESSION BY LICENSED OT 26 113.000000 8131.4800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 29 166.000000 11945.3600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 249.000000 17774.1200 71.3820
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 34.000000 2446.6400 71.9600
TRAV-TRAVS-Travel by mile 1157 89784.00000 39877.3400 0.4441
Subtotal (Total Children Is Unduplicated) 1239 98180.25000 237517.5400 2.4192
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Total 98531.750000 259441.1900 2.6331
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Number of Children (Unduplicated) With at Least One Service 1319
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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 4433 92092.750000 242555.6500 242555.6500
D 134 1347.000000 3860.9200 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
290 5059.500000 10968.6200 0.0000
Other 18 32.500000 2056.0000 0.0000
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Total 4875 98531.750000 259441.1900 242555.6500