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:EIP DEI DEIP
Payclass Filters:MED
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 404 958.750000 35501.4500 37.0289
Subtotal (Total Children Is Unduplicated) 404 958.750000 35501.4500 37.0289
-----------------------------------------------------------------------------------------------------------------------
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 51 100.000000 7500.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 54.000000 4050.0000 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 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 97.500000 5411.2500 55.5000
SCREEN-T1023-SCREENING 12 12.000000 600.0000 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) 100 309.500000 20454.0100 66.0873
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 124 579.750000 28987.5000 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) 147 692.250000 37083.0000 53.5688
-----------------------------------------------------------------------------------------------------------------------
Total 1960.500000 93038.4600 47.4565
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 447
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 35 36.750000 2493.7200 0.0000
U 0 0.000000 0.0000 0.0000
B 1028 1012.250000 48531.2900 27.9000
P 782 791.000000 37394.7000 158259.0800
D 0 0.000000 0.0000 0.0000
S 96 73.500000 2771.6000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
45 47.000000 1847.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1986 1960.500000 93038.4600 158286.9800