CMS/EIP Fiscal Report Center: 03
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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 493 457.250000 17009.7000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1116 2714.750000 100988.7000 37.2000
Subtotal (Total Children Is Unduplicated) 1190 3173.750000 117998.4000 37.1795
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 1.750000 87.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.000000 75.0000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 48.000000 3600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 24 46.500000 3391.4900 72.9353
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 22.000000 1650.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 129 259.500000 14402.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 29 49.500000 3712.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.000000 300.0000 75.0000
NURS-T1001-NURSING ASSESSMENT 1 1.000000 50.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 19 19.000000 950.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 12 12.000000 559.7800 46.6483
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 257.0500 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.9300 52.9300
Subtotal (Total Children Is Unduplicated) 229 503.750000 31367.6200 62.2682
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 134 148.250000 7412.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 49 47.750000 2387.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 3.250000 81.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 21 33.750000 1687.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 9 10.750000 537.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 57 69.750000 3487.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 4 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 45 60.750000 3037.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 80 119.750000 5987.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 10 12.000000 600.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 23 58.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 21 24.000000 1200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 86 211.750000 10562.5000 49.8819
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 207 818.750000 40937.5000 50.0000
INTR-T1013-INTERPRETER 6 28.750000 1437.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 540 2653.000000 26530.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 13 46.000000 3310.1600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 3.000000 215.8800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 25 99.750000 7121.5800 71.3943
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 57 215.750000 14867.7200 68.9118
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 8.000000 575.6800 71.9600
TRAV-TRAVS-Travel by mile 521 47896.00000 21303.3100 0.4448
Subtotal (Total Children Is Unduplicated) 655 52575.75000 153652.5400 2.9225
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Total 56253.250000 303018.5600 5.3867
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Number of Children (Unduplicated) With at Least One Service 1354
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Center 03
Flag Claims Units Chgs Paid
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R 49 63.500000 2362.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 1969 1331.000000 50937.6500 0.0000
P 234 500.250000 6264.1800 6193.4800
D 18 13.500000 710.1000 0.0000
S 15 128.000000 707.8100 707.8100
H 29 250.000000 483.2200 483.2200
T 0 0.000000 0.0000 0.0000
9634 53796.250000 234992.5000 0.0000
Other 186 170.750000 6560.9000 0.0000
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Total 12134 56253.250000 303018.5600 7384.5100