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:TPIN
Eligibility Filter:Program Patients
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 5 9.500000 712.5000 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 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 64 120.500000 9037.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 43 82.000000 6150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 26 49.500000 3712.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 89 169.500000 9407.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 42.500000 3187.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 10 39.000000 2064.2700 52.9300
Subtotal (Total Children Is Unduplicated) 156 541.000000 35933.4600 66.4204
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 27.000000 1350.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 56 261.000000 18781.5600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 4 18.000000 1295.2800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 80 439.000000 31530.5800 71.8236
PHY-97110GT-PT SESSION BY LICENSED PT 4 16.000000 1151.3600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 165 899.000000 64692.0400 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 60.000000 4317.6000 71.9600
TRAV-TRAVS-Travel by mile 16 618.000000 255.4700 0.4134
Subtotal (Total Children Is Unduplicated) 272 2338.000000 123373.8900 52.7690
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Total 2899.500000 160069.9500 55.2061
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Number of Children (Unduplicated) With at Least One Service 404
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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 435 1462.500000 89547.8500 89547.8500
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 31 495.000000 5263.5300 5263.5300
364 867.000000 59672.5700 0.0000
Other 38 75.000000 5586.0000 0.0000
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Total 868 2899.500000 160069.9500 94811.3800