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
Agency Filter:EXT
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 1 0.250000 9.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.250000 9.3000 37.2000
Subtotal (Total Children Is Unduplicated) 2 0.500000 18.6000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 46 85.500000 6262.5000 73.2456
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 24.000000 1800.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 46.000000 2553.0000 55.5000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 33.000000 1285.2500 38.9470
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 88 217.500000 13821.6200 63.5477
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 14.250000 712.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 10 7.000000 350.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 14 9.000000 225.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 26 96.750000 4837.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 28 33.500000 1675.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 26 55.500000 2775.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 2.500000 62.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 18.750000 937.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 218 960.750000 48037.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 100 449.000000 6735.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 310 1359.000000 16308.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 17 92.000000 6620.3200 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 7 11.000000 576.0000 52.3636
OCCT-97530TL-OT SESSION BY LICENSED OT 14 54.000000 3885.8400 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 2 2.000000 115.2000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 16 45.000000 3238.2000 71.9600
PHY-97110HM-PT SESSION BY PT ASST 14 50.000000 2820.4400 56.4088
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 3 4.000000 230.2400 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 9 32.000000 2302.7200 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 6 22.000000 1266.3200 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 51 206.750000 14517.9300 70.2197
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 0.500000 35.9800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 36 137.500000 9894.5000 71.9600
TRAV-TRAVS-Travel by mile 153 7639.000000 3398.4700 0.4449
Subtotal (Total Children Is Unduplicated) 383 11304.25000 131670.1600 11.6478
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Total 11522.250000 145510.3800 12.6286
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Number of Children (Unduplicated) With at Least One Service 443
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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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3393 10360.250000 79420.7000 79420.7000
1081 1162.000000 66089.6800 73.9000
Other 0 0.000000 0.0000 0.0000
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Total 4474 11522.250000 145510.3800 79494.6000