CMS/EIP Fiscal Report Center: 52
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
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 16.000000 1200.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 17 42.000000 2945.4100 70.1288
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 71 89.750000 4463.4300 49.7318
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 113 143.500000 7175.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 55 49.250000 1231.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 101 281.750000 14068.7500 49.9335
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 4 4.250000 212.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 13 9.250000 231.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 59 119.000000 5950.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 7 5.750000 287.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 47 302.750000 15137.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 14 10.250000 512.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 35 60.750000 3037.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 50.000000 2500.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 779 9505.000000 95042.0000 9.9992
OCCT-97530-OT SESSION BY LICENSED OT 1 13.000000 935.4800 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 3.000000 215.3600 71.7867
PHY-97110-PT SESSION BY LICENSED PT 2 2.500000 179.3800 71.7520
PHY-97110HM-PT SESSION BY PT ASST 2 8.000000 210.3800 26.2975
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 1.000000 7.7800 7.7800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 29.750000 2140.8100 71.9600
TRAV-TRAVS-Travel by mile 519 54897.00000 24424.8500 0.4449
Subtotal (Total Children Is Unduplicated) 849 65589.00000 178075.7200 2.7150
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Total 65631.000000 181021.1300 2.7582
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Number of Children (Unduplicated) With at Least One Service 855
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Center 52
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 8729 65577.000000 180768.3300 180746.2900
6 52.000000 152.8000 127.8000
Other 1 2.000000 100.0000 100.0000
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Total 8736 65631.000000 181021.1300 180974.0900