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
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 1045 1816.250000 67415.5000 37.1180
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 16.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 503 911.250000 33842.6500 37.1387
Subtotal (Total Children Is Unduplicated) 1150 2744.000000 101258.1500 36.9017
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Screening, Eval, and Assessment,Class #02
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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 13 23.000000 1725.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 13 23.500000 1762.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 33 60.000000 3330.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 59 139.000000 8986.7300 64.6527
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 71.9600 71.9600
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 353 995.250000 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 61 234.500000 11725.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 18 38.000000 1900.0000 50.0000
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 4 8.000000 575.6800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 1 5.250000 377.7900 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 37.000000 2662.5200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 143.9200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 287.8400 71.9600
TRAV-TRAVS-Travel by mile 267 13377.00000 5951.6300 0.4449
Subtotal (Total Children Is Unduplicated) 642 17566.00000 81841.4500 4.6591
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Total 20449.000000 192086.3300 9.3934
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Number of Children (Unduplicated) With at Least One Service 1338
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Center 53
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 1 0.250000 9.3000 0.0000
P 0 0.000000 0.0000 0.0000
D 139 98.750000 4166.1700 0.0000
S 11 5.750000 248.6600 0.0000
H 0 0.000000 0.0000 0.0000
T 1815 12246.000000 31333.8200 31324.5200
8487 8083.500000 155695.5300 0.0000
Other 22 14.750000 632.8500 0.0000
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Total 10475 20449.000000 192086.3300 31324.5200