CMS/EIP Fiscal Report Center: 57
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 889 3683.000000 136977.4500 37.1918
Subtotal (Total Children Is Unduplicated) 889 3683.000000 136977.4500 37.1918
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 15.000000 1125.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 13.000000 975.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 17 32.000000 1776.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 173 309.000000 23145.7500 74.9053
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 44 78.500000 5887.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 43 71.500000 5362.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 236 431.000000 23920.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 36.500000 2737.5000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 278 989.500000 65131.1600 65.8223
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 1 8.000000 575.6800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 5.000000 359.8000 71.9600
Subtotal (Total Children Is Unduplicated) 2 13.000000 935.4800 71.9600
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Total 4685.500000 203044.0900 43.3346
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Number of Children (Unduplicated) With at Least One Service 896
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Center 57
Flag Claims Units Chgs Paid
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R 148 213.750000 7951.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2057 3058.500000 131236.5000 0.0000
P 909 1413.250000 63856.0900 63846.4960
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 3114 4685.500000 203044.0900 63846.4960