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:EIP DEI DEIP
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 1082 4053.750000 150725.1000 37.1816
Subtotal (Total Children Is Unduplicated) 1082 4053.750000 150725.1000 37.1816
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 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 6 10.500000 582.7500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 41 72.500000 5408.2500 74.5966
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 24 42.500000 3187.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 114 220.000000 12210.0000 55.5000
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 167 372.000000 23258.0500 62.5216
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 36 148.250000 7412.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 2.500000 179.9000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 7 26.500000 1906.9400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 23.000000 1655.0800 71.9600
Subtotal (Total Children Is Unduplicated) 46 205.250000 11492.2600 55.9915
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Total 4631.000000 185475.4100 40.0508
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Number of Children (Unduplicated) With at Least One Service 1088
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Center 09
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 3374 3601.000000 141764.6000 211.0000
P 1002 1023.750000 43392.3500 43313.5600
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
5 5.000000 271.9600 0.0000
Other 1 1.250000 46.5000 0.0000
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Total 4382 4631.000000 185475.4100 43524.5600