CMS/EIP Fiscal Report Center: 54
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 949 3817.750000 142011.0000 37.1976
Subtotal (Total Children Is Unduplicated) 949 3817.750000 142011.0000 37.1976
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 7.000000 525.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 29 52.500000 3937.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 18.000000 1350.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 74 139.500000 10462.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 19.500000 1462.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 40 73.500000 5512.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 35 70.000000 3885.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 48.000000 3600.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 98.500000 7387.5000 75.0000
Subtotal (Total Children Is Unduplicated) 230 562.500000 40588.5000 72.1573
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 82 270.750000 13537.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 61 172.250000 8612.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 11.000000 791.5600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 5.000000 359.8000 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 59 241.500000 17378.3400 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 24 65.000000 4677.4000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 11 45.000000 3238.2000 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 46 204.000000 14679.8400 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 12 21.750000 1565.1300 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 8.000000 575.6800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 33 119.750000 8617.2100 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 19 44.750000 3220.2100 71.9600
Subtotal (Total Children Is Unduplicated) 272 1208.750000 77253.3700 63.9118
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Total 5589.000000 259852.8700 46.4936
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Number of Children (Unduplicated) With at Least One Service 967
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Center 54
Flag Claims Units Chgs Paid
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R 16 18.750000 842.6200 0.0000
U 0 0.000000 0.0000 0.0000
B 1083 1029.500000 50927.2200 109.1600
P 4842 4540.750000 208083.0300 207779.7200
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 5941 5589.000000 259852.8700 207888.8800