CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1121 2941.000000 108798.5000 36.9937
Subtotal (Total Children Is Unduplicated) 1121 2941.000000 108798.5000 36.9937
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 4.500000 337.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 75.000000 5625.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 139 243.500000 18262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 34.500000 2587.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 92 161.500000 12112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 19.000000 1425.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 45 81.000000 6075.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 54.500000 3024.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 126 225.000000 12487.5000 55.5000
Subtotal (Total Children Is Unduplicated) 263 931.000000 64150.5000 68.9049
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 703 4496.000000 224800.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 142 426.000000 21220.0000 49.8122
OCCT-97530-OT SESSION BY LICENSED OT 8 29.500000 2107.4800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 3 6.500000 464.3600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 6 29.000000 1601.6000 55.2276
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.500000 143.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 12 48.500000 3464.8400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 4 9.000000 642.9600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 9 27.500000 1571.9000 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 4 4.500000 257.2200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 27 80.500000 5750.9200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 21 66.500000 4750.7600 71.4400
Subtotal (Total Children Is Unduplicated) 815 5226.000000 266775.0400 51.0477
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Total 9098.000000 439724.0400 48.3319
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Number of Children (Unduplicated) With at Least One Service 1287
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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 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
10083 9097.000000 439687.0400 0.0000
Other 2 1.000000 37.0000 0.0000
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Total 10085 9098.000000 439724.0400 0.0000