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
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-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 3 5.500000 412.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 10 19.000000 1425.0000 75.0000
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 39 64.500000 3579.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 31.000000 2325.0000 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) 80 150.000000 9653.5500 64.3570
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 342 1845.000000 92250.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 58 121.500000 6075.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 55.500000 3916.8000 70.5730
OCCT-97530GT-OT SESSION BY LICENSED OT 7 17.750000 1268.0600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 27 126.500000 9037.1600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 5 5.000000 291.9800 58.3960
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 54 283.500000 20052.0600 70.7304
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 21 72.250000 5161.5400 71.4400
Subtotal (Total Children Is Unduplicated) 426 2528.000000 138062.6000 54.6134
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Total 2678.000000 147716.1500 55.1591
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Number of Children (Unduplicated) With at Least One Service 473
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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 1560 1566.750000 86052.3300 86052.3300
D 197 214.500000 12492.4800 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 876 888.750000 48583.8400 48068.0700
2 2.000000 137.5000 0.0000
Other 3 6.000000 450.0000 0.0000
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Total 2638 2678.000000 147716.1500 134120.4000