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
Agency Filter:EXT
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 1 0.250000 9.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.500000 18.6000 37.2000
Subtotal (Total Children Is Unduplicated) 1 0.750000 27.9000 37.2000
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Screening, Eval, and Assessment,Class #02
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 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-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 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 7 13.000000 721.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 10 20.000000 1500.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 32.500000 1803.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 61 120.000000 6660.0000 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 6 11.500000 862.5000 75.0000
Subtotal (Total Children Is Unduplicated) 112 241.000000 14691.7500 60.9616
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 20.000000 1633.1200 81.6560
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 21 19.250000 962.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 34 31.250000 1562.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 37 42.250000 2112.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 5 4.000000 200.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 0.500000 25.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 10.000000 250.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 349 1215.500000 60775.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 183 410.000000 20500.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 261 815.000000 12225.0000 15.0000
INTR-T1013-INTERPRETER 13 29.000000 984.9900 33.9652
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 210 731.000000 8772.0000 12.0000
PHY-97110-PT SESSION BY LICENSED PT 13 34.000000 2446.6400 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 2 3.000000 215.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 214.250000 15417.4300 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 143.9200 71.9600
TRAV-TRAVS-Travel by mile 428 20826.00000 9264.2400 0.4448
Subtotal (Total Children Is Unduplicated) 536 24409.50000 137578.2200 5.6363
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Total 24651.250000 152297.8700 6.1781
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Number of Children (Unduplicated) With at Least One Service 581
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Center 54
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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3201 19512.640000 65213.3000 64812.2000
2036 5138.610000 87084.5700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5237 24651.250000 152297.8700 64812.2000