CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 413 903.750000 33495.3500 37.0626
Subtotal (Total Children Is Unduplicated) 413 903.750000 33495.3500 37.0626
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 63 124.000000 9300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 62.000000 4650.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 60 119.500000 6632.2500 55.5000
SCREEN-T1023-SCREENING 11 11.000000 550.0000 50.0000
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 308.4600 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 4 10.000000 529.3000 52.9300
Subtotal (Total Children Is Unduplicated) 114 364.500000 24175.0100 66.3238
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 123 578.750000 28937.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 287.8400 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 23 106.500000 7663.7400 71.9600
Subtotal (Total Children Is Unduplicated) 146 691.250000 37033.0000 53.5740
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Total 1959.500000 94703.3600 48.3304
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Number of Children (Unduplicated) With at Least One Service 457
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Center 52
Flag Claims Units Chgs Paid
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R 37 40.750000 2754.7200 0.0000
U 0 0.000000 0.0000 0.0000
B 1068 1071.000000 51655.2400 27.9000
P 820 847.750000 40293.4000 161156.9800
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1925 1959.500000 94703.3600 161184.8800