CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 223.5000 63.8571
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 0.7500 0.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 20 36.000000 2518.8100 69.9669
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 11 20.500000 1500.0000 73.1707
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 29 52.500000 2868.0000 54.6286
Subtotal (Total Children Is Unduplicated) 33 120.000000 7483.0600 62.3588
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 27.000000 1350.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 86.750000 6029.8600 69.5085
OCCT-97530GT-OT SESSION BY LICENSED OT 8 13.000000 828.0500 63.6962
OCCT-97530HM-OT SESSION BY OT ASST 10 45.000000 1481.4000 32.9200
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.500000 143.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 25 93.750000 6532.5700 69.6807
PHY-97110GT-PT SESSION BY LICENSED PT 5 12.500000 893.0000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 9 32.500000 1857.7000 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 2 3.500000 200.0600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 87 350.500000 23819.8700 67.9597
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 33 99.250000 7030.4200 70.8355
Subtotal (Total Children Is Unduplicated) 164 767.250000 50215.9300 65.4492
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Total 887.250000 57698.9900 65.0313
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Number of Children (Unduplicated) With at Least One Service 195
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Center 06
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 501 305.250000 19555.6500 19555.6500
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 0 0.000000 0.0000 0.0000
860 582.000000 38143.3400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1361 887.250000 57698.9900 19555.6500