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
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 47 55.500000 2775.0000 50.0000
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 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 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 20 40.000000 3000.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 13 25.000000 1875.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 36.000000 1998.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 29.000000 2175.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 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) 122 237.500000 15173.4900 63.8884
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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 77 97.000000 4850.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 30 41.750000 2087.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 3.750000 93.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 181 278.000000 13875.2500 49.9110
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 98 96.000000 4760.0000 49.5833
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.750000 18.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 72 85.750000 4287.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 74 75.000000 3750.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 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 45 41.750000 2087.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 48 41.000000 2050.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 11 16.000000 800.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 131 2083.750000 104187.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 36 256.250000 12812.5000 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
TRAV-TRAVS-Travel by mile 370 43240.00000 19225.9100 0.4446
Subtotal (Total Children Is Unduplicated) 730 55910.00000 297844.4900 5.3272
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Total 56147.500000 313017.9800 5.5749
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Number of Children (Unduplicated) With at Least One Service 747
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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 13627 53280.000000 291616.3100 291530.6470
1006 2867.500000 21401.6700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 14633 56147.500000 313017.9800 291530.6470