CMS/EIP Fiscal Report Center: 06
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:MED
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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 6 19.000000 1356.7500 71.4079
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 676 4490.000000 224420.0000 49.9822
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 127 403.000000 20150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 80.250000 5702.8300 71.0633
OCCT-97530GT-OT SESSION BY LICENSED OT 2 6.000000 395.7800 65.9633
OCCT-97530HM-OT SESSION BY OT ASST 5 18.250000 1050.6600 57.5704
OCCT-97530HMGT-OT SESSION BY OT ASST 2 2.000000 100.7800 50.3900
PHY-97110-PT SESSION BY LICENSED PT 16 70.500000 5019.2100 71.1945
PHY-97110GT-PT SESSION BY LICENSED PT 5 26.500000 1906.9400 71.9600
PHY-97110HM-PT SESSION BY PT ASST 10 40.750000 2345.5700 57.5600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 5 11.000000 633.1600 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 64.000000 4584.9800 71.6403
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 19 69.250000 4947.2500 71.4404
Subtotal (Total Children Is Unduplicated) 775 5281.500000 271257.1600 51.3599
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Total 5300.500000 272613.9100 51.4317
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Number of Children (Unduplicated) With at Least One Service 777
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Center 06
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 0 0.000000 0.0000 0.0000
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
5451 5300.500000 272613.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5451 5300.500000 272613.9100 0.0000