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:TPIN
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 8 27.250000 1012.9000 37.1706
Subtotal (Total Children Is Unduplicated) 8 27.250000 1012.9000 37.1706
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 145.1100 41.4600
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 51 97.000000 7225.0000 74.4845
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 33 61.000000 4480.0000 73.4426
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 31 57.500000 4312.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 63 120.000000 6560.0000 54.6667
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 33.500000 2512.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 118 389.000000 26307.4800 67.6285
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 23.000000 1150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 36 232.000000 16585.9700 71.4913
OCCT-97530GT-OT SESSION BY LICENSED OT 3 11.500000 827.5400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 50 306.500000 21498.3900 70.1416
PHY-97110GT-PT SESSION BY LICENSED PT 1 9.000000 378.0400 42.0044
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 128 906.000000 61777.0700 68.1866
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 9 47.000000 3346.1200 71.1940
Subtotal (Total Children Is Unduplicated) 202 1535.000000 105563.1300 68.7708
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Total 1951.250000 132883.5100 68.1017
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Number of Children (Unduplicated) With at Least One Service 309
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Center 09
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 369 1069.750000 75010.0100 75399.6800
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 155 467.000000 29356.8400 29356.8400
167 362.000000 24618.1600 0.0000
Other 28 52.500000 3898.5000 0.0000
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Total 719 1951.250000 132883.5100 104756.5200