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
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 1814.750000 67359.7000 37.1179
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 16.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 502 909.250000 33768.2500 37.1386
Subtotal (Total Children Is Unduplicated) 1149 2740.500000 101127.9500 36.9013
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 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 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 12.000000 900.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 15.000000 1125.0000 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 17 32.000000 1776.0000 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) 29 77.000000 5073.0000 65.8831
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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 353 995.250000 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 17 47.500000 2375.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 9.000000 450.0000 50.0000
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 2 3.000000 215.8800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 1 5.250000 377.7900 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 29.000000 2086.8400 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
Subtotal (Total Children Is Unduplicated) 462 2911.750000 47171.2300 16.2003
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Total 5729.250000 153372.1800 26.7700
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Number of Children (Unduplicated) With at Least One Service 1266
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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 1 0.250000 9.3000 0.0000
8008 5611.000000 148361.7000 0.0000
Other 20 13.250000 577.0500 0.0000
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Total 8180 5729.250000 153372.1800 0.0000