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:EIP DEI DEIP
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 384 158.500000 5877.6000 37.0826
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 38 21.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 741 1700.750000 63156.3000 37.1344
Subtotal (Total Children Is Unduplicated) 864 1880.250000 69033.9000 36.7153
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 83 168.500000 12123.1000 71.9472
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 16 32.000000 2400.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 93.000000 6771.2000 72.8086
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 28 57.500000 4147.5200 72.1308
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 116 231.500000 12848.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 11 11.000000 550.0000 50.0000
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 22.000000 1131.0200 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 10.000000 514.1000 51.4100
Subtotal (Total Children Is Unduplicated) 193 683.500000 44398.0100 64.9569
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 40 45.250000 2312.5000 51.1050
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 10 8.500000 425.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 9.250000 231.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 58 112.500000 5625.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 1.750000 87.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 10.750000 537.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 20.000000 1000.0000 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 1519.500000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 262 1164.250000 58212.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 32 139.500000 7000.0000 50.1792
EPIC-99601-Early Steps Professional Development Fee 61 239.000000 3585.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 187 958.000000 11496.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 9.000000 647.6400 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 3 5.000000 288.0000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 4 10.250000 737.5900 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 4 8.000000 460.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 31 118.000000 8491.2800 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 12 44.000000 3166.2400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 32 151.500000 10597.9800 69.9537
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 7 34.000000 2446.6400 71.9600
TRAV-TRAVS-Travel by mile 253 19469.00000 8661.7000 0.4449
Subtotal (Total Children Is Unduplicated) 403 24081.25000 126197.6200 5.2405
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Total 26645.000000 239629.5300 8.9934
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Number of Children (Unduplicated) With at Least One Service 936
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Center 52
Flag Claims Units Chgs Paid
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R 44 41.250000 2184.6600 0.0000
U 0 0.000000 0.0000 0.0000
B 610 623.500000 32054.2400 109.1600
P 1361 1341.500000 65166.7000 63890.6200
D 83 83.750000 6087.6500 0.0000
S 328 264.250000 10522.2000 180.0200
H 89 110.250000 7993.7000 0.0000
T 2952 21255.500000 59177.2200 50416.4100
2456 2925.000000 56443.1600 272.5300
Other 0 0.000000 0.0000 0.0000
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Total 7923 26645.000000 239629.5300 114868.7400