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
Payclass Filters:GR
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 3103.500000 115450.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 686 1962.250000 72995.7000 37.2000
Subtotal (Total Children Is Unduplicated) 1531 5065.750000 188445.9000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 106 176.000000 8800.0000 50.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 28 47.000000 3495.7500 74.3777
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 14 24.500000 1837.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 18.000000 1350.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 39 71.500000 4007.2500 56.0455
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 178 340.000000 19644.7300 57.7786
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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 34 79.250000 0.5000 0.0063
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 4.000000 200.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 6 14.000000 700.0000 50.0000
INTR-T1013-INTERPRETER 83 353.250000 17662.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 3.000000 215.8800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.750000 125.9300 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 15.000000 1079.4000 71.9600
TRAV-TRAVS-Travel by mile 15 455.000000 202.4800 0.4450
Subtotal (Total Children Is Unduplicated) 151 969.750000 21996.1500 22.6823
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Total 6375.500000 230086.7800 36.0892
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Number of Children (Unduplicated) With at Least One Service 1609
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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 4994 5665.250000 203494.6300 203494.6300
D 0 0.000000 0.0000 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
711 706.750000 26329.6500 0.0000
Other 2 3.500000 262.5000 0.0000
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Total 5707 6375.500000 230086.7800 203494.6300