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:EIP DEI DEIP
Payclass Filters:MED
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 485 1217.000000 45198.0000 37.1389
Subtotal (Total Children Is Unduplicated) 485 1217.000000 45198.0000 37.1389
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 14.500000 1087.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 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 60 121.000000 9075.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 40 80.000000 6000.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 16.000000 1200.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 91 181.000000 10045.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
SCREEN-T1023-SCREENING 17 17.000000 850.0000 50.0000
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 7 29.000000 1534.9700 52.9300
Subtotal (Total Children Is Unduplicated) 147 490.500000 31833.7900 64.9007
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 118 679.250000 33962.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 3.750000 187.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 4.000000 230.4000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 1 3.000000 215.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 52.9400 52.9400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 26 99.000000 7086.0000 71.5758
Subtotal (Total Children Is Unduplicated) 145 792.000000 41879.1400 52.8777
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Total 2499.500000 118910.9300 47.5739
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Number of Children (Unduplicated) With at Least One Service 519
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Center 52
Flag Claims Units Chgs Paid
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R 17 19.000000 845.8400 0.0000
U 0 0.000000 0.0000 0.0000
B 826 835.000000 42160.2400 0.0000
P 1477 1510.000000 69635.3000 69635.9500
D 1 1.000000 50.0000 0.0000
S 137 116.000000 5442.9500 570.1000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
16 18.500000 776.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2474 2499.500000 118910.9300 70206.0500