CMS/EIP Fiscal Report Center: 53
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
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 1045 1816.250000 67415.5000 37.1180
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 16.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1110 2444.000000 90759.5500 37.1357
Subtotal (Total Children Is Unduplicated) 1269 4276.750000 158175.0500 36.9849
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 103.3600 103.3600
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 8.8100 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 28.9200 28.9200
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 19.000000 1425.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 10 20.000000 1110.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 21.000000 1575.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 60 110.500000 8287.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 10.500000 787.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 42 85.500000 6412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 46 80.000000 6000.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 120 232.000000 12848.2500 55.3804
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 26.000000 1950.0000 75.0000
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 5.000000 257.0500 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 5.000000 257.0500 51.4100
Subtotal (Total Children Is Unduplicated) 225 671.500000 44921.3500 66.8970
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 2031.9600 1015.9800
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 9 7.750000 387.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 19 14.250000 712.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 8 8.500000 425.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 95 52.000000 2600.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 33 42.000000 2037.5000 48.5119
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 64 54.750000 2687.5000 49.0868
CONPF-CONPF-CONSULT, PT, FACE TO FACE 25 43.000000 2150.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 133 66.250000 3312.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 3.000000 75.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 41 51.250000 2537.5000 49.5122
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 154 119.500000 5975.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 353 997.750000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 321 1165.250000 58262.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 132 289.000000 14437.2000 49.9557
EPIC-99601-Early Steps Professional Development Fee 474 2062.000000 30930.0000 15.0000
INTR-T1013-INTERPRETER 5 4.750000 257.1100 54.1284
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 151 334.000000 4008.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 52 229.000000 16478.8400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 17 32.500000 2338.7000 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 33 109.500000 7879.6200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 18 47.500000 3382.1200 71.2025
PHY-97110-PT SESSION BY LICENSED PT 28 120.000000 8803.2400 73.3603
PHY-97110GT-PT SESSION BY LICENSED PT 6 5.250000 377.7900 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 43 225.000000 16191.0000 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 16 18.000000 1295.2800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 54 215.500000 15507.3800 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 19.250000 1385.2300 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 56 171.000000 12305.1600 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 21 48.750000 3508.0500 71.9600
TRAV-TRAVS-Travel by mile 267 13377.00000 5951.6300 0.4449
Subtotal (Total Children Is Unduplicated) 677 19936.25000 228280.8100 11.4505
-----------------------------------------------------------------------------------------------------------------------
Total 24884.500000 431377.2100 17.3352
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1408
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 23.250000 903.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 454 415.750000 22448.4400 0.0000
P 2332 2162.680000 108623.3300 108430.7300
D 275 236.940000 12974.0400 0.0000
S 121 119.380000 4845.9500 0.0000
H 89 90.500000 6468.9700 0.0000
T 1869 12301.500000 36060.0300 36050.7300
9778 9409.000000 233331.2000 0.0000
Other 163 125.500000 5721.9500 203.7000
---------------------------------------------------------
Total 15108 24884.500000 431377.2100 144685.1600