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: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 632 461.250000 17158.5000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 81 68.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1411 4156.250000 154436.8000 37.1577
Subtotal (Total Children Is Unduplicated) 1443 4686.000000 171595.3000 36.6187
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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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 600.0000 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 1 2.000000 150.0000 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 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 555.0000 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 7 12.000000 900.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 17 33.000000 2475.0000 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 18 35.000000 2625.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 34 67.500000 3746.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 38.000000 2850.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 54.000000 4050.0000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 208 489.500000 34595.4400 70.6751
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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 11 24.000000 1727.0400 71.9600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 30 25.250000 1262.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 89 99.750000 4987.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 11 9.500000 475.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 192 100.500000 5000.0000 49.7512
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 35 38.500000 1925.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 137 53.000000 2650.0000 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 2 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 120 458.500000 22925.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 53 128.000000 6400.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 345 1213.000000 18195.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 129 398.000000 4814.0000 12.0955
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 31 106.500000 7831.7800 73.5378
PHY-97110GT-PT SESSION BY LICENSED PT 2 1.750000 125.9300 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 32 145.860000 10497.4200 71.9691
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 6.000000 431.7600 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
Subtotal (Total Children Is Unduplicated) 615 5231.750000 156677.8700 29.9475
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Total 10407.250000 362868.6100 34.8669
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Number of Children (Unduplicated) With at Least One Service 1482
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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 1 0.250000 9.3000 0.0000
8277 6413.750000 176587.9400 0.0000
Other 152 124.000000 5645.7200 0.0000
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Total 12774 10407.250000 362868.6100 134838.0500