CMS/EIP Fiscal Report Center: 54
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 633 461.500000 17167.8000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 81 68.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1411 4156.750000 154455.4000 37.1577
Subtotal (Total Children Is Unduplicated) 1443 4686.750000 171623.2000 36.6188
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 3 3.000000 310.0800 103.3600
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 103.3600 103.3600
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 16 17.000000 824.5000 48.5000
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 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 12.500000 937.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 12 23.000000 1276.5000 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 24.000000 1800.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 23 45.000000 3375.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 34.500000 2587.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 50 99.000000 7425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 32.000000 2400.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 28 55.000000 4125.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 40.000000 2220.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 95 187.500000 10406.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 40.000000 3000.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 33 65.500000 4912.5000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 227 730.500000 49287.1900 67.4705
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 7 7.000000 296.8700 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 24 44.000000 3360.1600 76.3673
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 45 44.500000 2225.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 117 131.000000 6550.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 48 51.750000 2587.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 195 104.500000 5200.0000 49.7608
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 45 48.000000 2400.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 239 109.750000 5462.5000 49.7722
CONOP-CONOP-CONSULT, OT, PHONE 2 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 36 39.500000 1975.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 138 53.500000 2675.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 39 56.000000 2800.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 163 80.750000 4037.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.750000 43.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 426 1392.250000 228.5000 0.1641
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 14.000000 350.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 469 1674.000000 83700.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 235 538.000000 26900.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 542 2028.000000 30420.0000 15.0000
INTR-T1013-INTERPRETER 13 29.000000 984.9900 33.9652
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 324 1129.000000 13586.0000 12.0337
OCCT-97530-OT SESSION BY LICENSED OT 55 227.520000 16373.7200 71.9661
OCCT-97530GT-OT SESSION BY LICENSED OT 21 30.000000 2158.8000 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 61 176.980000 12734.1000 71.9522
OCCT-97530TLGT-OT SESSION BY LICENSED OT 20 44.000000 3166.2400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 44 140.500000 10278.4200 73.1560
PHY-97110GT-PT SESSION BY LICENSED PT 4 4.750000 341.8100 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 44 164.750000 11855.4100 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 10 11.500000 827.5400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 70 360.110000 25914.8500 71.9637
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 8.000000 575.6800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 18 64.890000 4668.1500 71.9394
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 3.500000 251.8600 71.9600
TRAV-TRAVS-Travel by mile 428 20826.00000 9264.2400 0.4448
Subtotal (Total Children Is Unduplicated) 895 29641.25000 294256.0900 9.9273
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Total 35058.500000 515166.4800 14.6945
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Number of Children (Unduplicated) With at Least One Service 1520
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Center 54
Flag Claims Units Chgs Paid
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R 27 23.250000 899.6600 0.0000
U 0 0.000000 0.0000 0.0000
B 565 527.250000 24092.0900 0.0000
P 3316 2948.580000 134985.2900 134838.0500
D 289 218.800000 10442.6200 0.0000
S 23 21.390000 1266.5300 0.0000
H 124 129.980000 8939.4600 0.0000
T 3202 19512.890000 65222.6000 64812.2000
10313 11552.360000 263672.5100 0.0000
Other 152 124.000000 5645.7200 0.0000
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Total 18011 35058.500000 515166.4800 199650.2500