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: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 865 3299.000000 122713.5000 37.1972
Subtotal (Total Children Is Unduplicated) 865 3299.000000 122713.5000 37.1972
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 600.0000 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 2 2.500000 187.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 16 31.000000 2325.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 50 97.000000 7275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 13.000000 975.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 23 45.500000 3412.5000 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 25 50.000000 2775.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 40.000000 3000.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 47 98.000000 7350.0000 75.0000
Subtotal (Total Children Is Unduplicated) 163 424.000000 30591.0000 72.1486
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 84 288.750000 14437.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 65 182.250000 9112.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 14.000000 1007.4400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 4 7.000000 503.7200 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 59 243.500000 17522.2600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 25 67.000000 4821.3200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 13 48.000000 3454.0800 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 48 209.000000 15039.6400 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 13 22.750000 1637.0900 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 9.000000 647.6400 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 34 122.750000 8833.0900 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 21 47.750000 3436.0900 71.9600
Subtotal (Total Children Is Unduplicated) 280 1261.750000 80452.3700 63.7625
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Total 4984.750000 233756.8700 46.8944
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Number of Children (Unduplicated) With at Least One Service 882
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Center 54
Flag Claims Units Chgs Paid
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R 15 17.750000 805.4200 0.0000
U 0 0.000000 0.0000 0.0000
B 986 913.250000 45206.5200 109.1600
P 4330 3916.500000 180403.4300 180221.3200
D 49 56.750000 3449.3000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 5.000000 359.8000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 94 75.500000 3532.4000 329.9200
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Total 5479 4984.750000 233756.8700 180660.4000