CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 537 1255.500000 46425.7500 36.9779
Subtotal (Total Children Is Unduplicated) 537 1255.500000 46425.7500 36.9779
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 4.500000 249.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 55 94.500000 7087.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 35 61.500000 4612.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 23 36.000000 2700.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.500000 138.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 56 96.000000 5328.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 28.500000 2137.5000 75.0000
Subtotal (Total Children Is Unduplicated) 143 344.000000 23752.5000 69.0480
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 28.000000 1400.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 106 307.000000 15350.0000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 3 4.500000 321.4800 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 14 31.000000 2214.6400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 21 39.500000 2821.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 2 5.000000 357.2000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 4 4.000000 285.7600 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 24 61.250000 4375.7000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 24 41.500000 2964.7600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 5.000000 357.2000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 142.8800 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 18 28.000000 2000.2800 71.4386
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 61 185.750000 13269.9800 71.4400
Subtotal (Total Children Is Unduplicated) 239 742.500000 45861.7600 61.7667
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Total 2342.000000 116040.0100 49.5474
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Number of Children (Unduplicated) With at Least One Service 621
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Center 53
Flag Claims Units Chgs Paid
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R 36 35.000000 1415.8800 0.0000
U 0 0.000000 0.0000 0.0000
B 1668 1578.500000 79670.1100 9.2500
P 743 728.500000 34954.0200 34954.0600
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2447 2342.000000 116040.0100 34963.3100