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
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 20 16.250000 812.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 36.500000 2637.5000 72.2603
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 24 44.500000 3337.5000 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 6 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 15.500000 860.2500 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 183 345.000000 25532.4000 74.0070
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 163 314.000000 22841.1500 72.7425
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 99 181.500000 13612.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 4.500000 295.5000 65.6667
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 121 227.000000 12598.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
NURS-T1001-NURSING ASSESSMENT 1 1.000000 50.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 6 6.000000 308.4600 51.4100
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 15 18.000000 897.9700 49.8872
PSTH-97162-PT EVAL MODERATE COMPLEXITY 8 8.000000 373.8700 46.7338
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 21 22.000000 1073.8800 48.8127
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 31 32.000000 1644.0400 51.3763
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 89.7200 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 10.000000 529.3000 52.9300
Subtotal (Total Children Is Unduplicated) 598 1331.750000 90464.3000 67.9289
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 5.000000 631.9800 126.3960
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 438 575.000000 28725.0000 49.9565
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 326 351.000000 17550.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 5.750000 143.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 19 28.250000 1412.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 3 4.000000 200.0000 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
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 76 110.750000 5537.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 292 1990.250000 99512.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 380 2758.750000 137937.5000 50.0000
INTR-T1013-INTERPRETER 17 129.000000 6282.5000 48.7016
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1045 12188.00000 121718.0000 9.9867
OCCT-97530-OT SESSION BY LICENSED OT 23 207.250000 14373.6800 69.3543
OCCT-97530GT-OT SESSION BY LICENSED OT 11 13.000000 873.0700 67.1592
PHY-97110-PT SESSION BY LICENSED PT 53 609.000000 42827.3300 70.3240
PHY-97110GT-PT SESSION BY LICENSED PT 8 22.000000 1581.5600 71.8891
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 126 942.000000 62434.9700 66.2792
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 28 41.000000 2950.3600 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 1.500000 55.5000 37.0000
TRAV-TRAVS-Travel by mile 997 224888.0000 100040.2700 0.4448
Subtotal (Total Children Is Unduplicated) 1275 246013.2500 701975.4700 2.8534
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Total 247345.000000 792439.7700 3.2038
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Number of Children (Unduplicated) With at Least One Service 1487
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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 25791 195595.750000 606129.6100 606129.6100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1118 6705.250000 31800.8600 31788.3600
T 0 0.000000 0.0000 0.0000
6299 45044.000000 154509.3000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 33208 247345.000000 792439.7700 637917.9700