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
Agency Filter:EXT
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 4 6.500000 487.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 51 96.500000 7087.5000 73.4456
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 38.000000 2700.0000 71.0526
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 16.000000 1200.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 42.000000 2331.0000 55.5000
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92522TL-EVAL OF SPCH SOUND PROD 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 3 8.000000 370.5100 46.3138
Subtotal (Total Children Is Unduplicated) 107 236.000000 15894.8400 67.3510
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 17 20.500000 1025.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 36 33.500000 1675.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 10.750000 268.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 32 48.000000 2400.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 3.000000 150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.250000 6.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 26.000000 1300.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 5 2.500000 125.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 19 53.500000 2675.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.750000 87.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 9.000000 450.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 200 768.500000 38225.0000 49.7398
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 346 1796.000000 17960.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 28 101.000000 7052.0800 69.8226
OCCT-97530GT-OT SESSION BY LICENSED OT 2 1.750000 125.9300 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 8 48.000000 2764.8000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 22 72.250000 5199.1100 71.9600
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 0.500000 28.8000 57.6000
OCCT-97530TLHM-OT SESSION BY OT ASST 10 56.000000 3225.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 27 80.500000 5792.6900 71.9589
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 143.9200 71.9600
PHY-97110HM-PT SESSION BY PT ASST 15 68.000000 3914.0800 57.5600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 5 7.000000 402.9200 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 27 73.750000 5307.0500 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.750000 53.9700 71.9600
PHY-97110TLGTHM-PT SESSION BY PT ASST 1 1.000000 57.5600 57.5600
PHY-97110TLHM-PT SESSION BY PT ASST 6 35.000000 2014.6000 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 36 187.750000 12403.0500 66.0615
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 39 194.000000 13960.2400 71.9600
TRAV-TRAVS-Travel by mile 203 10080.00000 4484.8900 0.4449
Subtotal (Total Children Is Unduplicated) 370 13786.00000 133416.2900 9.6777
-----------------------------------------------------------------------------------------------------------------------
Total 14022.000000 149311.1300 10.6483
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 432
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 1966 12480.000000 56275.8700 56102.4500
907 1542.000000 93035.2600 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2873 14022.000000 149311.1300 56152.4500