CMS/EIP Fiscal Report Center: 51
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
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 20 22.000000 1650.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 32 32.000000 1776.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 3.000000 225.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 31.000000 2325.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 9.000000 675.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 7 7.000000 359.8700 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 9 18.000000 915.0000 50.8333
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 77 131.500000 8505.0100 64.6769
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EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 0.750000 37.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 34 146.250000 7224.0000 49.3949
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 21.000000 1050.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 450 2692.000000 32474.0000 12.0632
OCCT-97530-OT SESSION BY LICENSED OT 48 209.250000 14815.8100 70.8043
OCCT-97530GT-OT SESSION BY LICENSED OT 3 8.250000 575.6800 69.7794
OCCT-97530HM-OT SESSION BY OT ASST 31 183.750000 10306.9200 56.0921
OCCT-97530HMGT-OT SESSION BY OT ASST 1 3.000000 172.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 25 95.500000 6815.7800 71.3694
PHY-97110GT-PT SESSION BY LICENSED PT 1 2.500000 179.9000 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 97 425.500000 30136.8200 70.8268
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 11.000000 791.5600 71.9600
Subtotal (Total Children Is Unduplicated) 458 3801.750000 104730.7700 27.5480
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Total 3933.250000 113235.7800 28.7894
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Number of Children (Unduplicated) With at Least One Service 485
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Center 51
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 1327 3909.500000 112118.0200 112118.0200
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
5 23.750000 1117.7600 45.0000
Other 0 0.000000 0.0000 0.0000
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Total 1332 3933.250000 113235.7800 112163.0200