CMS/EIP Fiscal Report Center: 09
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:MED
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 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 450.0000 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 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 53 103.500000 7762.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 29 58.000000 4350.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 37 70.000000 5250.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 32 61.000000 3385.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 39.000000 2925.0000 75.0000
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 140 373.000000 26476.9000 70.9836
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 678 5280.000000 263601.0000 49.9244
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 34 155.000000 7750.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 47 318.000000 22717.9200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 8.000000 571.5200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 50 421.250000 30094.1000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 18 91.000000 6501.0400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 111 855.000000 61081.2000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 42.000000 3000.4800 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 9.000000 642.9600 71.4400
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 8.000000 111.0400 13.8800
Subtotal (Total Children Is Unduplicated) 815 7187.250000 396071.2600 55.1075
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Total 7560.250000 422548.1600 55.8908
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Number of Children (Unduplicated) With at Least One Service 867
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Center 09
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 0 0.000000 0.0000 0.0000
2232 7391.750000 411217.1600 0.0000
Other 88 168.500000 11331.0000 0.0000
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Total 2320 7560.250000 422548.1600 0.0000