CMS/EIP Fiscal Report Center: 10
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
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 10 13.000000 668.3300 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 13 16.000000 822.5600 51.4100
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 6.000000 1419.1000 236.5167
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 49 47.250000 2362.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 265 234.000000 11700.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 19 12.250000 306.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 57 85.000000 4250.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 238 354.500000 17725.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 10.000000 500.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 29 39.750000 1987.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 8.750000 437.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 80 110.750000 5537.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 28 37.000000 1850.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 141 205.750000 10287.5000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 3.000000 150.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 10.000000 500.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 420 3271.500000 163575.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 226 1121.750000 56087.5000 50.0000
EPIC-99601-Early Steps Professional Development Fee 349 2835.000000 42237.0000 14.8984
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1226 11459.00000 137508.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 59 265.750000 19123.3700 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 0.500000 35.9800 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 9 40.500000 2310.4000 57.0469
PHY-97110-PT SESSION BY LICENSED PT 54 232.500000 16730.7000 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 2 3.500000 251.8600 71.9600
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.5600 57.5600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 2 7.000000 402.9200 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 170 957.000000 68865.7200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 17 40.500000 2914.3800 71.9600
Subtotal (Total Children Is Unduplicated) 1726 21399.50000 569113.2400 26.5947
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Total 21415.500000 569935.8000 26.6132
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Number of Children (Unduplicated) With at Least One Service 1726
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Center 10
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 10116 21356.750000 568499.8700 568499.8700
D 8 12.000000 226.0000 0.0000
S 40 45.750000 1159.9300 100.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 1.000000 50.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10165 21415.500000 569935.8000 568599.8700