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:TPIN
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 2 14.000000 518.0000 37.0000
Subtotal (Total Children Is Unduplicated) 2 14.000000 518.0000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 11 21.000000 1115.5000 53.1190
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 63 121.000000 8925.0000 73.7603
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 43 82.500000 6147.5000 74.5152
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 21 38.500000 2887.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 114 216.500000 11742.7000 54.2388
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 35.000000 2625.0000 75.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 31.0500 31.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 133.1500 44.3833
Subtotal (Total Children Is Unduplicated) 168 558.500000 36215.5000 64.8442
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 23 110.000000 7729.8000 70.2709
OCCT-97530GT-OT SESSION BY LICENSED OT 2 6.000000 388.6400 64.7733
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 6.750000 482.2200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 41 229.000000 16185.1700 70.6776
PHY-97110GT-PT SESSION BY LICENSED PT 6 34.000000 2428.9600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 88 497.000000 35272.0300 70.9699
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 51.000000 3248.5600 63.6973
Subtotal (Total Children Is Unduplicated) 148 936.750000 65885.3800 70.3340
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Total 1509.250000 102618.8800 67.9933
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Number of Children (Unduplicated) With at Least One Service 291
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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 0 0.000000 0.0000 0.0000
P 261 612.500000 40558.4400 40863.2800
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 4 8.000000 444.0000 0.0000
327 750.750000 51266.4400 225.0000
Other 71 138.000000 10350.0000 0.0000
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Total 663 1509.250000 102618.8800 41088.2800