CMS/EIP Fiscal Report Center: 55
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: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
EVAL-96111-DEVELOPMENTAL EVALUATION 1 1.000000 50.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 1.000000 50.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 50 90.458666 6784.4000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.229866 767.2400 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 62 109.688532 8055.8700 73.4431
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 58.500000 4209.6600 71.9600
Subtotal (Total Children Is Unduplicated) 9 58.500000 4209.6600 71.9600
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Total 168.188532 12265.5300 72.9273
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Number of Children (Unduplicated) With at Least One Service 69
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Center 55
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 69 110.500000 8142.4700 0.0000
T 0 0.000000 0.0000 0.0000
53 57.688532 4123.0600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 122 168.188532 12265.5300 0.0000