CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 Page: 1
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.000000 750.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 20.000000 1110.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 24 39.500000 2192.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 46.000000 3450.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 40.500000 3037.5000 75.0000
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 205.6400 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 6.000000 317.5800 52.9300
Subtotal (Total Children Is Unduplicated) 74 203.500000 13775.4500 67.6926
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EI Services,Class #03
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 6.250000 312.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 325 1170.750000 58537.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 17 37.500000 1875.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 23 68.000000 4893.2800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 5 8.250000 593.6700 71.9600
PHY-97110-PT SESSION BY LICENSED PT 29 111.750000 8041.5300 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 4 4.000000 287.8400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 69 273.500000 19681.0600 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 15 61.250000 4407.5500 71.9600
Subtotal (Total Children Is Unduplicated) 400 1741.250000 98629.9300 56.6432
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Total 1944.750000 112405.3800 57.7994
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Number of Children (Unduplicated) With at Least One Service 456
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Center 01
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 693 700.500000 41266.1900 41266.1900
D 35 37.000000 2147.6400 0.0000
S 0 0.000000 0.0000 0.0000
H 150 180.000000 12223.5200 0.0000
T 917 924.000000 49762.4000 49628.8200
75 88.750000 5966.8800 0.0000
Other 9 14.500000 1038.7500 0.0000
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Total 1879 1944.750000 112405.3800 90895.0100