CMS/EIP Fiscal Report Center: 57
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 669 574.000000 21352.8000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1376 5502.750000 204702.3000 37.2000
Subtotal (Total Children Is Unduplicated) 1432 6076.750000 226055.1000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 4 8.250000 412.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 35.000000 2625.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 9.500000 712.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 44.500000 2469.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 253 393.500000 29512.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 16.000000 1200.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 123 173.500000 13012.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 372 604.000000 33522.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 19.500000 1462.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 7.000000 359.8700 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 8 8.000000 411.2800 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 8 8.000000 411.2800 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 257.0500 51.4100
SPCH-92522-EVAL OF SPCH SOUND PROD 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 19 19.000000 997.3400 52.4916
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 12.000000 863.5200 71.9600
Subtotal (Total Children Is Unduplicated) 463 1384.750000 89622.6200 64.7212
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 0.750000 37.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 109 110.000000 5500.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 16 16.000000 800.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 5.000000 250.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 8 8.000000 400.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 154 157.000000 7850.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 45 45.000000 2250.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 238.000000 5950.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 6.000000 300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1139 7865.000000 393250.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 41 177.000000 8654.0000 48.8927
EPIC-99601-Early Steps Professional Development Fee 660 4581.000000 68247.0000 14.8978
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 612 4098.000000 49176.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 67 356.750000 25671.7300 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 4.000000 287.8400 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 17 91.000000 5241.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 12 47.000000 3382.1200 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 6.000000 431.7600 71.9600
PHY-97110HM-PT SESSION BY PT ASST 36 216.750000 12476.1300 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 62 302.000000 21731.9200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 20.000000 1439.2000 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 49 209.000000 11980.8000 57.3244
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 4.000000 230.4000 57.6000
TRAV-TRAVS-Travel by mile 3 1251.000000 556.6700 0.4450
Subtotal (Total Children Is Unduplicated) 1242 19814.25000 626094.6700 31.5982
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Total 27275.750000 941772.3900 34.5278
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Number of Children (Unduplicated) With at Least One Service 1792
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Center 57
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 1739 2640.500000 116664.0000 0.0000
P 28 33.104924 2219.9900 1663.2500
D 162 187.540857 6507.1000 0.0000
S 6 9.000000 587.2500 0.0000
H 270 401.750000 14945.1000 14945.1000
T 5018 6853.750000 143821.9900 143821.9900
13256 16922.354219 648437.5800 200.0000
Other 219 227.750000 8589.3800 0.0000
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Total 20698 27275.750000 941772.3900 160630.3400