CMS/EIP Fiscal Report Center: 02
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1689 2679.750000 99568.3500 37.1558
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 511 659.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 402 1116.500000 41476.1000 37.1483
Subtotal (Total Children Is Unduplicated) 1759 4455.250000 141044.4500 31.6580
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 48 56.250000 2812.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 37 71.000000 5325.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 22 43.500000 3262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 82 156.000000 8602.5000 55.1442
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 22 41.000000 2275.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 74.000000 5550.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 47.000000 3525.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 11.1600 11.1600
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 205 534.250000 34264.7400 64.1362
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 3049.9900 1524.9950
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 87 109.000000 5450.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 51 73.750000 3687.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 4.750000 118.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 213 328.000000 16375.2500 49.9245
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 113 107.500000 5335.0000 49.6279
CONIP-CONIP-CONSULT, ITDS PHONE 3 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 81 96.250000 4812.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 78 79.250000 3962.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 6.000000 300.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 4 3.000000 150.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 2.250000 56.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 99 101.750000 5087.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 101 79.750000 3987.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 19 62.500000 3125.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 160 2332.500000 116625.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 44 296.250000 14812.5000 50.0000
INTR-T1013-INTERPRETER 48 342.250000 17087.5000 49.9270
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 582 9029.000000 90414.0000 10.0137
OCCT-97530-OT SESSION BY LICENSED OT 7 41.000000 2946.4600 71.8649
OCCT-97530GT-OT SESSION BY LICENSED OT 5 33.750000 2428.6500 71.9600
PHY-97110-PT SESSION BY LICENSED PT 10 34.250000 2275.4300 66.4359
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 58.750000 4225.0500 71.9157
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 9 6.000000 222.0000 37.0000
TRAV-TRAVS-Travel by mile 529 70766.00000 31473.1900 0.4448
Subtotal (Total Children Is Unduplicated) 827 83999.50000 338107.5200 4.0251
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Total 88989.000000 513416.7100 5.7694
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Number of Children (Unduplicated) With at Least One Service 1800
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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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 13628 53280.500000 291634.9100 291530.6470
1006 2867.500000 21401.6700 0.0000
Other 10828 32841.000000 200380.1300 0.0000
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Total 25462 88989.000000 513416.7100 291530.6470