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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.500000 18.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7 20.000000 744.0000 37.2000
Subtotal (Total Children Is Unduplicated) 7 20.500000 762.6000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 23 40.500000 3037.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 15.000000 1125.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 13.000000 975.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 50 96.000000 5328.0000 55.5000
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 84 183.000000 11626.2300 63.5313
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EI Services,Class #03
OCCT-97530GT-OT SESSION BY LICENSED OT 1 7.000000 503.7200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 21.000000 1511.1600 71.9600
Subtotal (Total Children Is Unduplicated) 6 28.000000 2014.8800 71.9600
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Total 231.500000 14403.7100 62.2190
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Number of Children (Unduplicated) With at Least One Service 94
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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 0 0.000000 0.0000 0.0000
P 9 13.000000 483.6000 483.6000
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
132 218.500000 13920.1100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 141 231.500000 14403.7100 483.6000