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
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 632 461.250000 17158.5000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 81 68.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 691 1694.750000 62971.3000 37.1567
Subtotal (Total Children Is Unduplicated) 1065 2224.500000 80129.8000 36.0215
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Screening, Eval, and Assessment,Class #02
AACIS-92597-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-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 13.500000 1012.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 19.500000 1462.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 13 26.000000 1443.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 68 133.000000 8864.8600 66.6531
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 4 4.000000 169.6400 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 5 10.000000 719.6000 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 44 47.000000 2350.0000 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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 13 47.000000 2350.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 29.000000 1450.0000 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 23 83.000000 5972.6800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 7 10.000000 719.6000 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 8 37.000000 2662.5200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 53.750000 3867.8500 71.9600
Subtotal (Total Children Is Unduplicated) 605 3901.750000 72312.0600 18.5332
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Total 6259.250000 161306.7200 25.7709
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Number of Children (Unduplicated) With at Least One Service 1225
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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 228 156.000000 6275.6400 0.0000
S 4 3.250000 24.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.250000 9.3000 0.0000
7955 6066.000000 153742.2800 0.0000
Other 42 33.750000 1255.5000 0.0000
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Total 8230 6259.250000 161306.7200 0.0000