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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 664 486.500000 18097.8000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 90 75.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1555 4959.500000 184308.4000 37.1627
Subtotal (Total Children Is Unduplicated) 1588 5521.000000 202406.2000 36.6611
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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 8 16.500000 1237.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 12.000000 900.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 6 12.000000 900.0000 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 19 35.500000 1970.2500 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 17 30.000000 2250.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 32 62.500000 4687.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 44.500000 3337.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 82 158.500000 11887.5000 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 52 102.000000 7650.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 46.000000 2553.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 151 296.500000 16455.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 61.500000 4612.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 70 134.500000 10087.5000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 355 1114.000000 75563.4400 67.8307
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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 196 105.000000 5225.0000 49.7619
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 46 48.500000 2425.0000 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 446 1407.750000 228.5000 0.1623
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 563 2054.000000 30810.0000 15.0000
INTR-T1013-INTERPRETER 13 29.000000 984.9900 33.9652
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 328 1134.000000 13646.0000 12.0335
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 437 20917.00000 9304.7300 0.4448
Subtotal (Total Children Is Unduplicated) 921 29779.75000 294796.5800 9.8992
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Total 36414.750000 572766.2200 15.7290
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Number of Children (Unduplicated) With at Least One Service 1666
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Center 54
Flag Claims Units Chgs Paid
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R 33 29.000000 1113.5600 0.0000
U 0 0.000000 0.0000 0.0000
B 627 608.750000 27687.8900 0.0000
P 3746 3502.330000 160312.4900 160165.2500
D 302 242.050000 11627.6200 0.0000
S 24 22.890000 1379.0300 0.0000
H 126 133.480000 9162.9600 0.0000
T 3242 19650.390000 68496.5300 68086.1300
10761 12097.110000 287090.5200 0.0000
Other 155 128.750000 5895.6200 0.0000
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Total 19016 36414.750000 572766.2200 228251.3800