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
Agency Filter:EXT
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-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
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 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.000000 222.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 12 19.000000 1054.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 14.000000 1050.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 20.000000 1500.0000 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 1 1.000000 51.4100 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) 43 76.000000 5024.7200 66.1147
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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 311 1145.750000 57287.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 13 30.500000 1525.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 44.000000 3166.2400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 4.000000 287.8400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 16 84.750000 6098.6100 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 143.9200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 51 223.500000 16083.0600 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 60.250000 4335.5900 71.9600
Subtotal (Total Children Is Unduplicated) 364 1601.000000 89240.2600 55.7403
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Total 1677.000000 94264.9800 56.2105
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Number of Children (Unduplicated) With at Least One Service 396
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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 0 0.000000 0.0000 0.0000
T 917 924.000000 49762.4000 49628.8200
1 1.000000 50.0000 0.0000
Other 9 14.500000 1038.7500 0.0000
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Total 1655 1677.000000 94264.9800 90895.0100