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
Agency Filter:EXT
Payclass Filters:TPIN
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 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 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 42.000000 2850.0000 67.8571
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 26.000000 1950.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 26.000000 1443.0000 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 8 8.000000 400.0000 50.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 12.000000 171.9900 14.3325
Subtotal (Total Children Is Unduplicated) 47 127.000000 7680.2200 60.4742
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 83 315.500000 15675.0000 49.6830
OCCT-97530-OT SESSION BY LICENSED OT 11 37.500000 2698.5000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 8 23.000000 1324.8000 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 34 159.000000 11327.0900 71.2396
Subtotal (Total Children Is Unduplicated) 145 710.500000 42290.0100 59.5215
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Total 837.500000 49970.2300 59.6659
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Number of Children (Unduplicated) With at Least One Service 177
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Center 52
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 0 0.000000 0.0000 0.0000
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 245 436.500000 26126.4200 26126.4200
224 401.000000 23843.8100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 469 837.500000 49970.2300 26126.4200