CMS/EIP Fiscal Report Center: 10
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
OCTH-97165-OT EVAL LOW COMPLEXITY 9 7.000000 359.8700 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 12 12.000000 616.9200 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 6 4.500000 231.3450 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 20 19.250000 989.6425 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 49 48.750000 2506.2375 51.4100
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 563 4552.250000 227612.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 451 2633.750000 131540.5000 49.9442
OCCT-97530-OT SESSION BY LICENSED OT 178 952.250000 68523.9100 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 30 85.750000 6170.5700 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 50 193.500000 11145.6000 57.6000
OCCT-97530HMGT-OT SESSION BY OT ASST 3 4.500000 259.2000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 244 1004.000000 72247.8400 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 8 19.000000 1367.2400 71.9600
PHY-97110HM-PT SESSION BY PT ASST 2 2.000000 115.1200 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 271 1638.750000 117924.4500 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 31 122.750000 8833.0900 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.750000 216.0000 57.6000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 9.750000 561.6000 57.6000
Subtotal (Total Children Is Unduplicated) 1285 11222.00000 646517.6200 57.6116
-----------------------------------------------------------------------------------------------------------------------
Total 11270.750000 649023.8575 57.5848
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1289
-----------------------------------------------------------------------------------------------------------------------
Center 10
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 2 5.000000 359.8000 40.0000
D 2 4.000000 221.9600 0.0000
S 3 7.000000 415.8800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3614 11254.750000 648026.2175 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3621 11270.750000 649023.8575 40.0000