CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 Page: 1
List order: No List
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 532 318.500000 11784.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1499 7710.250000 285229.3000 36.9935
Subtotal (Total Children Is Unduplicated) 1520 8028.750000 297013.8000 36.9938
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Screening, Eval, and Assessment,Class #02
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 63.1400 63.1400
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 19.000000 1425.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.500000 562.5000 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 5 7.500000 562.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 18 31.000000 1720.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 250 433.000000 32345.7500 74.7015
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 84 154.000000 11472.0000 74.4935
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 81 137.000000 10098.2500 73.7099
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 345 610.500000 33757.7500 55.2952
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 84.000000 6173.2500 73.4911
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 19 19.000000 969.9500 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 9 9.000000 459.4500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 28 28.000000 1429.4000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 482 1573.000000 102954.7900 65.4512
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 53 53.000000 2650.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 70 70.000000 3500.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 30 30.000000 750.0000 25.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 9 9.000000 450.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 44 44.000000 2200.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 110 110.000000 5500.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 14 14.000000 350.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 157.000000 3925.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 7.000000 350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 890 5781.000000 289050.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 68 278.500000 13925.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 896 6114.000000 61140.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 43 195.000000 13930.8000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.000000 214.3200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 47 126.500000 7235.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 12 18.500000 1321.6400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 4 12.500000 893.0000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 39 214.750000 12275.1100 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 59 153.750000 10983.9000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 15.000000 1071.6000 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 59 170.000000 9724.0000 57.2000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 7.000000 400.4000 57.2000
TRAV-TRAVS-Travel by mile 13 2003.000000 891.3100 0.4450
Subtotal (Total Children Is Unduplicated) 1023 15591.50000 442881.8800 28.4053
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Total 25193.250000 842850.4700 33.4554
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Number of Children (Unduplicated) With at Least One Service 1686
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Center 57
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 962 1516.750000 63268.2500 0.0000
P 1882 2575.500000 111138.7500 119585.7200
D 0 0.000000 0.0000 0.0000
S 14 14.500000 746.9000 746.9000
H 0 0.000000 0.0000 0.0000
T 2859 10729.250000 193925.0200 193511.7200
5177 10313.000000 472132.3000 251971.7200
Other 38 44.250000 1639.2500 640.2500
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Total 10932 25193.250000 842850.4700 566456.3100