CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
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-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 18.000000 999.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.500000 637.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 21.500000 1612.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 3.000000 158.7900 52.9300
Subtotal (Total Children Is Unduplicated) 37 73.000000 4874.1100 66.7686
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 5.000000 75.0000 15.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 2.000000 18.7500 9.3750
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 4.000000 50.0000 12.5000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 11 49.000000 1900.0000 38.7755
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 191 512.250000 24750.0000 48.3163
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 17 30.500000 1425.0000 46.7213
INTR-T1013-INTERPRETER 1 2.000000 100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 15.000000 1079.4000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 32 102.500000 7375.9000 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 45 142.000000 10218.3200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 21.000000 1457.1900 69.3900
Subtotal (Total Children Is Unduplicated) 267 888.250000 48665.4400 54.7880
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Total 961.250000 53539.5500 55.6978
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Number of Children (Unduplicated) With at Least One Service 301
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Center 01
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 296 320.000000 17045.4700 17045.4700
D 24 25.000000 1464.1400 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.500000 83.2500 0.0000
T 555 568.750000 31730.6900 31292.0600
3 5.000000 375.0000 0.0000
Other 22 41.000000 2841.0000 0.0000
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Total 901 961.250000 53539.5500 48337.5300