CMS/EIP Fiscal Report Center: 03
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Agency Filter:EXT
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 12 8.500000 425.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 71 132.500000 9756.6700 73.6352
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 71.000000 5047.7200 71.0946
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 37.500000 2812.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 90.500000 5022.7500 55.5000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 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-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 7 7.000000 359.8700 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 308.4600 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.9300 52.9300
Subtotal (Total Children Is Unduplicated) 186 389.500000 26187.4000 67.2334
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 138 152.250000 7612.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 79 72.250000 3612.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 6 6.000000 300.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 50 71.750000 3587.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 14 14.000000 700.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 30 42.000000 2100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 102 169.750000 8487.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 7 8.000000 400.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 21 21.000000 1050.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 119 295.500000 14775.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 221 947.000000 47350.0000 50.0000
INTR-T1013-INTERPRETER 4 45.500000 2150.0000 47.2527
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 564 3250.000000 32418.0000 9.9748
OCCT-97530-OT SESSION BY LICENSED OT 8 37.000000 2662.5200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 5 5.000000 359.8000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 24 94.000000 6710.2700 71.3859
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 62 246.000000 16618.8900 67.5565
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 13.250000 953.4700 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 0.750000 27.7500 37.0000
TRAV-TRAVS-Travel by mile 527 56706.00000 25228.0600 0.4449
Subtotal (Total Children Is Unduplicated) 665 62199.50000 177213.2200 2.8491
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Total 62589.000000 203400.6200 3.2498
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Number of Children (Unduplicated) With at Least One Service 764
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Center 03
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 1610 13007.000000 39356.4000 39356.4000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 905 5659.500000 21803.0200 21803.0200
T 0 0.000000 0.0000 0.0000
6060 43922.500000 142241.2000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8575 62589.000000 203400.6200 61159.4200