CMS/EIP Fiscal Report Center: 52
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: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 3 5.750000 213.9000 37.2000
Subtotal (Total Children Is Unduplicated) 3 5.750000 213.9000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 64 139.000000 9745.0000 70.1079
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 32 64.000000 4800.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 72 144.000000 7992.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 14 14.000000 700.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 8 20.000000 516.3300 25.8165
Subtotal (Total Children Is Unduplicated) 119 433.000000 27246.9700 62.9260
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 190 923.000000 45985.0000 49.8212
OCCT-97530-OT SESSION BY LICENSED OT 13 42.500000 3058.3000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 9 28.000000 1612.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 29 83.750000 6026.6500 71.9600
PHY-97110HM-PT SESSION BY PT ASST 12 88.750000 5050.8900 56.9114
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 3 2.000000 115.1200 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 72 352.250000 24113.2900 68.4550
Subtotal (Total Children Is Unduplicated) 275 1524.250000 86134.0100 56.5091
-----------------------------------------------------------------------------------------------------------------------
Total 1963.000000 113594.8800 57.8680
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 340
-----------------------------------------------------------------------------------------------------------------------
Center 52
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 56 75.000000 3998.2000 2832.9000
D 238 250.500000 13494.0000 165.0000
S 2 2.750000 203.9700 130.0000
H 222 264.000000 15552.5500 0.0000
T 647 863.000000 49922.9200 42706.6400
316 507.750000 30423.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1481 1963.000000 113594.8800 45834.5400