CMS/EIP Fiscal Report Center: 03
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 1571 1556.250000 57864.2000 37.1818
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 9 10.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1238 5387.750000 200143.4000 37.1479
Subtotal (Total Children Is Unduplicated) 2123 6954.750000 258007.6000 37.0980
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 6.000000 291.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 19 15.000000 750.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 31.000000 2325.0000 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 18 34.000000 2550.0000 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 4 6.000000 450.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.000000 750.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 25.000000 1387.5000 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 135 254.000000 19050.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 85 163.500000 12212.5000 74.6942
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 49 90.500000 6758.2500 74.6768
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 246 494.000000 27417.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 28.000000 1554.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 67.000000 5025.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
NURS-T1001-NURSING ASSESSMENT 1 1.000000 50.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 205.6400 51.4100
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 5 6.000000 281.0500 46.8417
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 47 48.000000 2400.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 13 13.000000 668.3300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 12 12.000000 616.5600 51.3800
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 89.7200 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 3 7.000000 370.5100 52.9300
Subtotal (Total Children Is Unduplicated) 581 1358.000000 88011.9100 64.8099
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.000000 331.9900 82.9975
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 456 616.500000 30800.0000 49.9594
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 341 375.000000 18750.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 7 6.750000 168.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 48 83.750000 4187.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 31 38.000000 1900.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 127 240.750000 12037.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 34 39.500000 1975.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 93 235.250000 11762.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 8 10.750000 537.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 177 502.250000 25112.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 56 115.250000 5762.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 111 259.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 45 63.750000 3187.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 274 1712.250000 85612.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 236 689.250000 34462.5000 50.0000
INTR-T1013-INTERPRETER 17 129.000000 6282.5000 48.7016
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1045 12185.00000 121688.0000 9.9867
OCCT-97530-OT SESSION BY LICENSED OT 16 133.500000 9601.7200 71.9230
OCCT-97530GT-OT SESSION BY LICENSED OT 7 10.000000 719.0800 71.9080
PHY-97110-PT SESSION BY LICENSED PT 41 316.750000 22664.7400 71.5540
PHY-97110GT-PT SESSION BY LICENSED PT 7 7.250000 521.1900 71.8883
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 88 477.750000 34262.6200 71.7166
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 18 24.000000 1726.5200 71.9383
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 1.500000 55.5000 37.0000
TRAV-TRAVS-Travel by mile 997 224852.0000 100024.2500 0.4448
Subtotal (Total Children Is Unduplicated) 1298 243128.7500 534134.3600 2.1969
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Total 251441.500000 880153.8700 3.5004
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Number of Children (Unduplicated) With at Least One Service 2414
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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 23077 192720.250000 448093.3500 448093.3500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 883 6441.500000 17873.7800 17861.2800
T 0 0.000000 0.0000 0.0000
18126 52276.250000 414016.2900 0.0000
Other 3 3.500000 170.4500 0.0000
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Total 42089 251441.500000 880153.8700 465954.6300