CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 Page: 1
List order: No List
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-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 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 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 16 28.000000 2100.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 12.000000 900.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 49 79.500000 4412.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.500000 1012.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 52.500000 3937.5000 75.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 90 215.000000 14177.5500 65.9421
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 352 1868.000000 93400.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 65 139.250000 6962.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 68.500000 4845.5200 70.7375
OCCT-97530GT-OT SESSION BY LICENSED OT 15 30.750000 2196.7800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 29 129.500000 9251.4800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 10 13.000000 863.5000 66.4231
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 309.500000 21909.5000 70.7900
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 23 74.250000 5304.4200 71.4400
Subtotal (Total Children Is Unduplicated) 453 2633.750000 144743.7000 54.9573
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Total 2848.750000 158921.2500 55.7863
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Number of Children (Unduplicated) With at Least One Service 503
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Center 01
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 1561 1567.750000 86102.3300 86052.3300
D 197 214.500000 12492.4800 0.0000
S 1 1.000000 71.4400 0.0000
H 119 131.750000 8539.2600 0.0000
T 876 888.750000 48583.8400 48068.0700
29 39.000000 2681.9000 0.0000
Other 3 6.000000 450.0000 0.0000
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Total 2786 2848.750000 158921.2500 134120.4000