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
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 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-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 17.500000 971.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 17.500000 971.2500 55.5000
Subtotal (Total Children Is Unduplicated) 24 55.000000 3442.5000 62.5909
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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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 53 163.750000 8187.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 30 55.500000 2775.0000 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 6 18.000000 1295.2800 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 2.000000 143.9200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 38.000000 2734.4800 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) 484 22800.00000 53109.4500 2.3294
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Total 22855.750000 56579.8500 2.4755
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Number of Children (Unduplicated) With at Least One Service 492
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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 2863 19165.500000 46606.2500 46205.1500
637 3690.250000 9973.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3500 22855.750000 56579.8500 46205.1500