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
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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 12 24.000000 1332.0000 55.5000
Subtotal (Total Children Is Unduplicated) 23 48.000000 2888.2500 60.1719
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.000000 854.9800 427.4900
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 54 181.250000 9062.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 43 94.500000 4725.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 2 5.000000 359.8000 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 48.000000 3454.0800 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 215.8800 71.9600
Subtotal (Total Children Is Unduplicated) 87 334.750000 18744.2000 55.9946
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Total 382.750000 21632.4500 56.5185
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Number of Children (Unduplicated) With at Least One Service 100
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Center 54
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 152 159.500000 8936.7200 8936.7200
210 223.250000 12695.7300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 362 382.750000 21632.4500 8936.7200