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:EIP DEI DEIP
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-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 18 31.500000 2312.5000 73.4127
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 14 25.500000 1817.5000 71.2745
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 58 110.000000 6005.0000 54.5909
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 82 178.500000 10832.9300 60.6887
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EI Services,Class #03
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.500000 179.9000 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 12.000000 863.5200 71.9600
Subtotal (Total Children Is Unduplicated) 6 14.500000 1043.4200 71.9600
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Total 220.250000 12889.2500 58.5210
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Number of Children (Unduplicated) With at Least One Service 94
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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 30 45.250000 2196.3400 2543.5300
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 5 12.500000 479.0500 479.0500
93 160.500000 10102.8600 0.0000
Other 1 2.000000 111.0000 0.0000
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Total 129 220.250000 12889.2500 3022.5800