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: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-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
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 33 65.500000 4912.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 19 35.500000 2662.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 29 53.500000 4012.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
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
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
Subtotal (Total Children Is Unduplicated) 90 210.500000 15474.5500 73.5133
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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 1 9.000000 647.6400 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 5 35.000000 2482.6000 70.9314
Subtotal (Total Children Is Unduplicated) 198 1520.500000 104519.7100 68.7404
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Total 1731.000000 119994.2600 69.3208
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Number of Children (Unduplicated) With at Least One Service 278
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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 339 1024.500000 72813.6700 72856.1500
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 150 454.500000 28877.7900 28877.7900
74 201.500000 14515.3000 0.0000
Other 27 50.500000 3787.5000 0.0000
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Total 590 1731.000000 119994.2600 101733.9400