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
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 930 3573.750000 132918.7000 37.1931
Subtotal (Total Children Is Unduplicated) 930 3573.750000 132918.7000 37.1931
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 12.000000 900.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.000000 375.0000 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 11 20.500000 1137.7500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 135 244.500000 18308.2500 74.8804
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 31 57.000000 4275.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 28 48.500000 3637.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 175 325.500000 18065.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 27.000000 2025.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 209 749.000000 49233.6200 65.7325
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 651 4318.250000 215912.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 50 151.500000 7575.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 16 75.285159 5417.5200 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 4 14.000000 806.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 6 24.000000 1727.0400 71.9600
PHY-97110HM-PT SESSION BY PT ASST 7 48.000000 2762.8800 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 58.000000 4173.6800 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 30.000000 1728.0000 57.6000
Subtotal (Total Children Is Unduplicated) 690 4719.035159 240103.0200 50.8797
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Total 9041.785159 422255.3400 46.7004
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Number of Children (Unduplicated) With at Least One Service 1069
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Center 57
Flag Claims Units Chgs Paid
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R 134 177.000000 6584.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 1781 2491.750000 105369.9500 0.0000
P 818 1243.250000 55285.3400 55276.3460
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 81 121.250000 4510.5000 4486.3000
1284 4723.535159 239903.8000 239476.0000
Other 259 285.000000 10601.3500 0.0000
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Total 4357 9041.785159 422255.3400 299238.6460