CMS/EIP Fiscal Report Center: 09
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: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
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 72 143.500000 10762.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 46 90.000000 6750.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 35 65.000000 4875.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 27 50.500000 2802.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 45.500000 3412.5000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 6 6.000000 308.4600 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 164 420.000000 30185.9400 71.8713
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 569 3772.000000 188600.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 22.000000 1100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 46 259.000000 18637.6400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 6.000000 431.7600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 35 223.000000 16047.0800 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 6 20.000000 1439.2000 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 5 8.000000 575.6800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 75 420.000000 30223.2000 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 19 54.000000 3885.8400 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 143.9200 47.9733
Subtotal (Total Children Is Unduplicated) 673 4788.000000 261156.2800 54.5439
-----------------------------------------------------------------------------------------------------------------------
Total 5208.000000 291342.2200 55.9413
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 791
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
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
1399 4904.500000 269642.4700 0.0000
Other 157 303.500000 21699.7500 0.0000
---------------------------------------------------------
Total 1556 5208.000000 291342.2200 0.0000