CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 599 1462.250000 54349.1000 37.1681
Subtotal (Total Children Is Unduplicated) 599 1462.250000 54349.1000 37.1681
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 10.500000 787.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 12.000000 900.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 68 119.000000 8925.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 40 70.000000 5250.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 13.500000 1012.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 39 63.000000 4725.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 76 136.500000 7575.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.500000 1312.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 33.000000 2475.0000 75.0000
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.9300 52.9300
Subtotal (Total Children Is Unduplicated) 212 502.000000 34780.9300 69.2847
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 101 380.750000 19037.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 76 139.750000 6987.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 6.000000 431.7600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 6.000000 431.7600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 27 77.500000 5576.9000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 17 28.000000 2014.8800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 2 2.000000 143.9200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 43 211.250000 15201.5500 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 9 8.000000 575.6800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 14.000000 1007.4400 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 10.000000 719.6000 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 33 95.500000 6872.1800 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 18 36.250000 2608.5500 71.9600
Subtotal (Total Children Is Unduplicated) 238 1015.000000 61609.2200 60.6987
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Total 2979.250000 150739.2500 50.5964
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Number of Children (Unduplicated) With at Least One Service 690
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Center 53
Flag Claims Units Chgs Paid
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R 6 5.250000 246.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 601 564.500000 29660.8800 0.0000
P 2538 2409.500000 120831.8700 120778.4900
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3145 2979.250000 150739.2500 120778.4900