CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
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 385 158.750000 5886.9000 37.0828
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 38 21.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 330 750.750000 27937.2000 37.2124
Subtotal (Total Children Is Unduplicated) 623 930.500000 33824.1000 36.3505
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 31 62.000000 3441.0000 55.5000
Subtotal (Total Children Is Unduplicated) 34 80.000000 4713.0000 58.9125
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 49 59.500000 3025.0000 50.8403
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 19 15.000000 750.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 24 18.250000 456.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 72 209.250000 10462.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 3 2.750000 137.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 26 31.500000 1575.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 37 65.250000 3262.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 2.500000 62.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 32 38.750000 1937.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 0.250000 12.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 150 1519.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 31 132.250000 6612.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 5.000000 250.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 156 687.000000 10305.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 466 2313.000000 27756.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 6.000000 431.7600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 287.8400 71.9600
TRAV-TRAVS-Travel by mile 372 26985.00000 12005.4500 0.4449
Subtotal (Total Children Is Unduplicated) 698 32096.00000 79367.3000 2.4728
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Total 33106.500000 117904.4000 3.5614
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Number of Children (Unduplicated) With at Least One Service 930
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Center 52
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 0 0.000000 0.0000 0.0000
D 7 9.000000 637.2000 0.0000
S 142 83.000000 2966.7000 0.0000
H 0 0.000000 0.0000 0.0000
T 5262 30478.500000 74675.3000 72956.1000
2144 2536.000000 39625.2000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7555 33106.500000 117904.4000 72956.1000