CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 Page: 1
List order: No List
Payclass Filters:OTHER
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 97 155.000000 5735.0000 37.0000
Subtotal (Total Children Is Unduplicated) 97 155.000000 5735.0000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 6.000000 450.0000 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 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 6.000000 333.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 64 99.500000 7462.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 44 67.000000 5025.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 106 163.500000 9074.2500 55.5000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 116 351.000000 22942.6000 65.3635
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 19 25.000000 1250.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 20 34.500000 1725.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 25 28.500000 712.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 4.000000 200.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 8.000000 400.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 7 12.000000 600.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 146 926.000000 46300.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 12.000000 600.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 34 169.000000 12073.3600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 58 359.000000 25361.2000 70.6440
PHY-97110GT-PT SESSION BY LICENSED PT 15 63.000000 4500.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 124 740.000000 52865.6000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 79.000000 5643.7600 71.4400
TRAV-TRAVS-Travel by mile 462 33358.00000 14658.1900 0.4394
Subtotal (Total Children Is Unduplicated) 584 35829.00000 167390.3300 4.6719
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Total 36335.000000 196067.9300 5.3961
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Number of Children (Unduplicated) With at Least One Service 703
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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 1 0.500000 18.5000 0.0000
P 1206 24697.000000 109440.4600 109440.4600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 300 459.500000 26777.0000 0.0000
T 0 0.000000 0.0000 0.0000
556 11178.000000 59831.9700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2063 36335.000000 196067.9300 109440.4600