CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2021 ending 06/30/2022 Date of Report:08/08/2022 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 1751 7751.750000 286777.7500 36.9952
Subtotal (Total Children Is Unduplicated) 1751 7751.750000 286777.7500 36.9952
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 13 25.000000 1875.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 17.500000 1312.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 11 21.500000 1193.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 18.000000 1350.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 232 422.500000 31687.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 17.500000 1312.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 152 282.500000 21187.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.000000 750.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 113 183.000000 13725.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 9.500000 527.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 253 460.000000 25530.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 10.500000 787.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 79 145.500000 10912.5000 75.0000
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 645 1661.000000 114860.4000 69.1514
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 105 438.000000 21900.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 286 2086.500000 104325.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 36.750000 2625.4200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 13 32.000000 2286.0800 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 30 175.250000 12519.8600 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 66 323.250000 23092.9800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 12 37.750000 2696.8600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 8 13.000000 928.7200 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 55 342.250000 24450.3400 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 51 208.250000 14877.3800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 29.000000 2071.7600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 13.000000 928.7200 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 70 349.800000 24989.0000 71.4380
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 129 1014.250000 72400.4600 71.3832
Subtotal (Total Children Is Unduplicated) 546 5099.050000 310092.5800 60.8138
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Total 14511.800000 711730.7300 49.0450
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Number of Children (Unduplicated) With at Least One Service 1776
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Center 53
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 160 166.000000 9137.4100 710.7500
P 11670 10730.300000 522577.2900 522449.7500
D 230 216.500000 14792.0300 0.0000
S 310 198.250000 7824.1900 0.0000
H 142 121.500000 6185.6900 9.2500
T 0 0.000000 0.0000 0.0000
3244 2896.750000 142508.6200 0.0000
Other 247 182.500000 8705.5000 286.7500
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Total 16003 14511.800000 711730.7300 523456.5000