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
Agency Filter:EXT
Payclass Filters:MED
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
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) 6 7.000000 359.8700 51.4100
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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 4726.035159 240462.8900 50.8805
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Number of Children (Unduplicated) With at Least One Service 691
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Center 57
Flag Claims Units Chgs Paid
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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 4 14.000000 986.8900 986.8900
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
1278 4712.035159 239476.0000 239476.0000
Other 0 0.000000 0.0000 0.0000
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Total 1282 4726.035159 240462.8900 240462.8900