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
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 1045 1814.750000 67359.7000 37.1179
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 16.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1109 2442.000000 90685.1500 37.1356
Subtotal (Total Children Is Unduplicated) 1268 4273.250000 158044.8500 36.9847
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Screening, Eval, and Assessment,Class #02
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 103.3600 103.3600
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 16.000000 1200.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 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 6 10.500000 582.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 17.500000 1312.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 49 86.500000 6487.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 26 50.000000 3750.0000 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 45 78.000000 5850.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 91 160.500000 8880.0000 55.3271
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) 192 502.500000 33977.1200 67.6162
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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 7 4.750000 237.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 19 14.250000 712.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 3.500000 175.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 95 52.000000 2600.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 24 25.000000 1187.5000 47.5000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 63 52.750000 2587.5000 49.0521
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 33 37.000000 1825.0000 49.3243
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 152 115.250000 5762.5000 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 135 458.250000 22912.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 46 86.500000 4312.2000 49.8520
EPIC-99601-Early Steps Professional Development Fee 297 1237.000000 18555.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 74 161.000000 1932.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 56.000000 4029.7600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 7 18.500000 1331.2600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 24 77.500000 5576.9000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 16 45.500000 3238.2000 71.1692
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 41 179.500000 12916.8200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 18.250000 1313.2700 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 52 152.000000 10937.9200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 21 48.750000 3508.0500 71.9600
Subtotal (Total Children Is Unduplicated) 474 4323.500000 137978.1500 31.9135
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Total 9099.250000 330000.1200 36.2667
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Number of Children (Unduplicated) With at Least One Service 1349
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Center 53
Flag Claims Units Chgs Paid
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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 1 0.250000 9.3000 0.0000
8335 5926.500000 168060.6400 0.0000
Other 161 124.000000 5666.1500 203.7000
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Total 11795 9099.250000 330000.1200 108634.4300