CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 Page: 1
List order: No List
Payclass Filters:OTHER
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
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 3 5.500000 326.3200 59.3309
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 40.000000 2000.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 4.000000 200.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 11 32.000000 320.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 3.000000 172.8000 57.6000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 15.000000 1079.4000 71.9600
Subtotal (Total Children Is Unduplicated) 25 96.000000 3916.1200 40.7929
-----------------------------------------------------------------------------------------------------------------------
Total 101.500000 4242.4400 41.7974
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 28
-----------------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
20 65.500000 3721.0300 3497.5300
Other 15 36.000000 521.4100 521.4100
---------------------------------------------------------
Total 35 101.500000 4242.4400 4018.9400