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:Program Patients
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 6 10.000000 750.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 21 36.000000 2700.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 14.000000 1050.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 64 101.500000 5633.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.000000 1275.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 42 74.500000 5587.5000 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) 121 278.500000 18481.8000 66.3619
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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 2912.250000 163225.5000 56.0479
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Number of Children (Unduplicated) With at Least One Service 534
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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 1571 1582.750000 87061.5800 87011.5800
D 200 220.000000 12904.9800 0.0000
S 1 1.000000 71.4400 0.0000
H 124 137.750000 8930.7600 0.0000
T 890 910.250000 49991.5900 49475.8200
40 54.500000 3815.1500 0.0000
Other 3 6.000000 450.0000 0.0000
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Total 2829 2912.250000 163225.5000 136487.4000