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
Payclass Filters:MED
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1141 4231.500000 157337.4000 37.1824
Subtotal (Total Children Is Unduplicated) 1141 4231.500000 157337.4000 37.1824
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 18.000000 1350.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 6.500000 487.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 12 22.500000 1248.7500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 143 273.500000 20454.0000 74.7861
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 87 167.000000 12525.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 56 102.500000 7687.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 178 338.500000 18786.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 52.000000 3900.0000 75.0000
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
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
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 257 1002.500000 67759.2400 67.5903
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 570 3773.000000 188650.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 47 170.250000 8512.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 48 261.000000 18781.5600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 4 8.500000 611.6600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 7 26.500000 1906.9400 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 76 421.000000 30295.1600 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 20 55.000000 3957.8000 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 4 26.000000 1799.0000 69.1923
Subtotal (Total Children Is Unduplicated) 710 4993.250000 272648.5400 54.6034
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Total 10227.250000 497745.1800 48.6685
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Number of Children (Unduplicated) With at Least One Service 1229
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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 3507 3795.250000 150734.1500 211.0000
P 1049 1099.250000 46852.8500 46770.8100
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
1416 4931.000000 271526.9300 0.0000
Other 210 401.750000 28631.2500 0.0000
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Total 6182 10227.250000 497745.1800 46981.8100