CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 9 8.500000 425.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 29 49.500000 3359.4100 67.8669
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 19.000000 950.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 5 4.000000 200.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 59 63.250000 3162.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 45 35.750000 1747.5000 48.8811
CONOF-CONOF-CONSULT, OT, FACE TO FACE 29 28.500000 1425.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 16 8.500000 425.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 3.500000 175.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 19 11.250000 562.5000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 9.000000 450.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 71 534.500000 26725.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 19 71.000000 3550.0000 50.0000
INTR-T1013-INTERPRETER 27 114.750000 5712.5000 49.7821
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 321 2307.000000 23070.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 10.000000 719.6000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 7.000000 503.7200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 1 1.500000 107.9400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 7.250000 521.7100 71.9600
TRAV-TRAVS-Travel by mile 146 10488.00000 4654.8500 0.4438
Subtotal (Total Children Is Unduplicated) 394 13726.75000 74737.8200 5.4447
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Total 13776.250000 78097.2300 5.6690
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Number of Children (Unduplicated) With at Least One Service 398
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Center 02
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 1 1.000000 10.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2955 12195.000000 63664.9300 63795.1860
759 1580.250000 14422.3000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3715 13776.250000 78097.2300 63795.1860