CMS/EIP Fiscal Report Center: 54
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 1953 2344.250000 87059.0500 37.1373
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 297 253.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 3039 20235.75000 751410.5500 37.1328
Subtotal (Total Children Is Unduplicated) 3077 22833.25000 838469.6000 36.7214
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 64 73.000000 3540.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 19 35.000000 2587.5000 73.9286
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 35 66.500000 4987.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 15 29.500000 2212.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 8.000000 600.0000 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 20 40.000000 2220.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 39.500000 2962.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 104 195.000000 14512.5000 74.4231
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 65 117.500000 8700.0000 74.0426
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 290 553.500000 41512.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 72 128.000000 9600.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 125 236.500000 17737.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 25.500000 1415.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 116 231.000000 12820.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 79 157.500000 11812.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 185 362.000000 27150.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 915 2339.500000 167282.1600 71.5034
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 48 122.000000 8804.4400 72.1675
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 131 113.250000 5662.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 328 420.000000 21000.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 73 35.750000 1775.0000 49.6503
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 706 504.750000 25212.5000 49.9505
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 102 121.000000 6050.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 886 603.250000 30100.0000 49.8964
CONOP-CONOP-CONSULT, OT, PHONE 4 2.500000 62.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 105 154.250000 7712.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 649 353.500000 17650.0000 49.9293
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 163 265.250000 13262.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 566 373.500000 18650.0000 49.9331
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 879 5459.750000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 4 4.000000 162.5000 40.6250
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 208 1421.750000 71062.5000 49.9824
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 202 1048.750000 52406.0000 49.9700
INTR-T1013-INTERPRETER 2 4.500000 225.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 875 6733.000000 67330.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 98 692.500000 50599.7100 73.0682
OCCT-97530GT-OT SESSION BY LICENSED OT 60 219.250000 16228.7000 74.0192
OCCT-97530TL-OT SESSION BY LICENSED OT 108 910.500000 65288.6400 71.7064
OCCT-97530TLGT-OT SESSION BY LICENSED OT 70 262.250000 18838.8800 71.8356
PHY-97110-PT SESSION BY LICENSED PT 88 785.000000 57933.3600 73.8005
PHY-97110GT-PT SESSION BY LICENSED PT 31 71.000000 5097.9800 71.8025
PHY-97110TL-PT SESSION BY LICENSED PT 99 888.750000 63835.8900 71.8266
PHY-97110TLGT-PT SESSION BY LICENSED PT 43 95.250000 6836.2500 71.7717
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 91 680.680000 48909.6600 71.8541
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 38 85.250000 6120.4200 71.7938
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 73 534.250000 38381.1900 71.8413
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 42 164.250000 11799.4100 71.8381
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.9600 13.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 88 110.750000 4097.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1377 23244.18000 741178.4900 31.8866
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Total 48416.930000 1746930.2500 36.0810
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Number of Children (Unduplicated) With at Least One Service 3078
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Center 54
Flag Claims Units Chgs Paid
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R 12 14.000000 520.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 2268 2096.000000 99920.9600 0.0000
P 18846 16863.450000 784833.7000 784289.7400
D 1520 1319.870000 71888.7300 0.0000
S 40 36.610000 1812.6700 37.2000
H 471 520.310000 37330.6500 0.0000
T 0 0.000000 0.0000 0.0000
37237 27100.000000 727797.3600 0.0000
Other 570 466.190000 22806.7800 1550.8300
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Total 60964 48416.430000 1746911.6500 785877.7700