CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 Page: 1
List order: No List
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 994 3584.000000 133177.0500 37.1588
Subtotal (Total Children Is Unduplicated) 994 3584.000000 133177.0500 37.1588
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 8.000000 561.0000 70.1250
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.500000 533.2500 71.1000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 108 208.000000 15600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 62 119.000000 8925.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 52 100.500000 7537.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 144 278.000000 15429.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 35.500000 2662.5000 75.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 255.6100 51.1220
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 201 784.000000 52896.3400 67.4698
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 686 4955.750000 247737.5000 49.9899
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 35 116.000000 5800.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 55 313.000000 22523.4800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 5.750000 413.7700 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 8 27.000000 1942.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 36 236.000000 16756.8800 71.0037
PHY-97110GT-PT SESSION BY LICENSED PT 2 7.000000 503.7200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 86 647.000000 46414.2000 71.7376
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 13.000000 935.4800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 7 23.000000 1655.0800 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 10.750000 773.5700 71.9600
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.9600 13.9600
Subtotal (Total Children Is Unduplicated) 804 6356.250000 345542.5200 54.3626
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Total 10724.250000 531615.9100 49.5714
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Number of Children (Unduplicated) With at Least One Service 1153
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Center 09
Flag Claims Units Chgs Paid
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R 7 4.000000 148.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 1726 1924.750000 77599.4700 5074.7600
P 2023 2175.250000 87384.4700 87278.9300
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 6 3.000000 111.6000 111.0000
1921 6378.250000 349895.1200 0.0000
Other 126 239.000000 16476.4500 0.0000
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Total 5809 10724.250000 531615.9100 92464.6900