CMS/EIP Fiscal Report Center: 06
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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 14 23.500000 1762.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 13 21.500000 1612.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 16 54.000000 4011.0000 74.2778
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 78.500000 5172.5100 65.8918
OCCT-97530GT-OT SESSION BY LICENSED OT 4 7.750000 517.6900 66.7987
OCCT-97530HM-OT SESSION BY OT ASST 14 55.250000 3325.1400 60.1835
OCCT-97530HMGT-OT SESSION BY OT ASST 3 5.000000 287.1000 57.4200
PHY-97110-PT SESSION BY LICENSED PT 20 69.750000 4734.5600 67.8790
PHY-97110GT-PT SESSION BY LICENSED PT 9 24.000000 1680.2600 70.0108
PHY-97110HM-PT SESSION BY PT ASST 11 40.250000 2298.1400 57.0966
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 8 17.000000 989.3200 58.1953
SENS-V5264-EARMOLD 1 1.000000 18.1300 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 218.750000 14946.3500 68.3262
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 26 89.000000 5419.1500 60.8893
Subtotal (Total Children Is Unduplicated) 134 608.250000 39488.3500 64.9212
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Total 662.250000 43499.3500 65.6842
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Number of Children (Unduplicated) With at Least One Service 148
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Center 06
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 326 240.750000 15088.9000 15088.9000
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
539 421.500000 28410.4500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 865 662.250000 43499.3500 15088.9000