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
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-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 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 64 127.000000 9525.0000 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 42 82.000000 6150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 36 68.500000 5137.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 34 63.500000 3524.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 35.500000 2662.5000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 255.6100 51.1220
Subtotal (Total Children Is Unduplicated) 157 409.000000 29171.1100 71.3230
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 685 4954.750000 247687.5000 49.9899
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 9.000000 450.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 53 310.000000 22307.6000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 5.000000 359.8000 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 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 85 646.000000 46342.2400 71.7372
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 11.000000 791.5600 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 7 23.000000 1655.0800 71.9600
Subtotal (Total Children Is Unduplicated) 776 6203.750000 336998.3000 54.3217
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Total 6612.750000 366169.4100 55.3732
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Number of Children (Unduplicated) With at Least One Service 867
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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 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
1920 6377.250000 349823.1600 0.0000
Other 122 235.500000 16346.2500 0.0000
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Total 2042 6612.750000 366169.4100 0.0000