CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
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 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 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
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 71 142.000000 10650.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 51 99.500000 7462.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 26 50.500000 3787.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 33 64.500000 3579.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 41.500000 3112.5000 75.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 4.000000 211.7200 52.9300
Subtotal (Total Children Is Unduplicated) 156 414.000000 29703.9700 71.7487
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 704 4735.000000 236514.2400 49.9502
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 31 70.000000 3500.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 37 241.250000 17360.3500 71.9600
PHY-97110-PT SESSION BY LICENSED PT 29 190.250000 13690.3900 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 2 10.000000 719.6000 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 65 483.000000 34756.6800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 16 47.000000 3382.1200 71.9600
Subtotal (Total Children Is Unduplicated) 780 5778.500000 310067.3000 53.6588
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Total 6192.500000 339771.2700 54.8682
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Number of Children (Unduplicated) With at Least One Service 874
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Center 09
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 0 0.000000 0.0000 0.0000
1754 5945.500000 322504.0200 0.0000
Other 125 247.000000 17267.2500 0.0000
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Total 1879 6192.500000 339771.2700 0.0000