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
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 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
Subtotal (Total Children Is Unduplicated) 3 8.000000 483.0000 60.3750
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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 9 6.500000 325.0000 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 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 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 8 42.000000 2100.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 99 448.000000 6720.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 310 1356.000000 16272.0000 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 152 7585.000000 3374.4400 0.4449
Subtotal (Total Children Is Unduplicated) 383 9677.250000 40698.5400 4.2056
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Total 9685.750000 41200.1400 4.2537
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Number of Children (Unduplicated) With at Least One Service 387
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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 2748 9685.250000 41181.5400 41181.5400
2 0.500000 18.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2750 9685.750000 41200.1400 41181.5400