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
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 1953 2344.250000 87059.0500 37.1373
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 297 253.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1656 7312.000000 271416.4500 37.1193
Subtotal (Total Children Is Unduplicated) 2685 9909.500000 358475.5000 36.1749
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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 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 18.000000 1350.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 20.500000 1462.5000 71.3415
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 37 71.500000 5362.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 25.000000 1875.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 23.000000 1725.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 36 71.500000 3968.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 36.000000 2700.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 27.500000 2062.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 192 405.500000 26637.1600 65.6897
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 28 69.000000 4996.8000 72.4174
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 5458.750000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 98.000000 4900.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 17 71.000000 3550.0000 50.0000
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 34 201.500000 14468.7400 71.8052
OCCT-97530GT-OT SESSION BY LICENSED OT 20 59.500000 4276.5500 71.8748
OCCT-97530TL-OT SESSION BY LICENSED OT 4 9.000000 642.9600 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 2.000000 143.4000 71.7000
PHY-97110-PT SESSION BY LICENSED PT 30 221.540000 15914.2000 71.8344
PHY-97110GT-PT SESSION BY LICENSED PT 9 20.250000 1455.2400 71.8637
PHY-97110TL-PT SESSION BY LICENSED PT 1 4.000000 287.3200 71.8300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 260.500000 18682.9300 71.7195
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 25.000000 1792.8900 71.7156
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 6 29.000000 2081.6400 71.7807
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 5 11.500000 824.6800 71.7113
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 88 110.750000 4097.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1348 16339.54000 292926.3500 17.9275
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Total 26654.540000 678039.0100 25.4380
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Number of Children (Unduplicated) With at Least One Service 2794
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Center 54
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 866 631.540000 28984.7200 0.0000
S 8 7.750000 40.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
36127 25878.500000 643935.2400 0.0000
Other 199 136.250000 5060.4500 0.0000
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Total 37200 26654.040000 678020.4100 0.0000