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:EIP DEI DEIP
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
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 106 176.000000 8800.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 14.500000 1048.5000 72.3103
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 3 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 7.500000 562.5000 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 11 17.000000 943.5000 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 131 223.000000 16658.2500 74.7007
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 86 134.500000 10087.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 47 83.500000 6337.5000 75.8982
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 208 352.500000 19594.5000 55.5872
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-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
Subtotal (Total Children Is Unduplicated) 453 1043.000000 66213.4900 63.4837
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 9 16.000000 800.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 2 3.000000 150.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 16 16.500000 412.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 4.000000 200.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 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-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 14.000000 700.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 34 85.500000 4275.0000 50.0000
INTR-T1013-INTERPRETER 83 353.250000 17662.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 6.000000 431.7600 71.9600
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
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 3.000000 215.8800 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 24.000000 1727.0400 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
TRAV-TRAVS-Travel by mile 15 455.000000 202.4800 0.4450
Subtotal (Total Children Is Unduplicated) 157 1089.000000 28373.8700 26.0550
-----------------------------------------------------------------------------------------------------------------------
Total 9341.500000 362799.3600 38.8374
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1803
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 5058 5727.500000 206065.7300 206065.7300
D 0 0.000000 0.0000 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
1072 1166.500000 47324.9000 130.2000
Other 3 3.750000 271.8000 0.0000
---------------------------------------------------------
Total 8303 9341.500000 362799.3600 299913.6100