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: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 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 12 24.000000 1800.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 11.500000 862.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 10 40.000000 2117.2000 52.9300
Subtotal (Total Children Is Unduplicated) 44 114.000000 7245.4300 63.5564
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 13 56.000000 2800.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 56 255.250000 18367.7900 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 11.000000 791.5600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 94 580.000000 41676.2900 71.8557
PHY-97110GT-PT SESSION BY LICENSED PT 4 22.000000 1583.1200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 166 1011.250000 72769.5500 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 10 29.000000 2086.8400 71.9600
Subtotal (Total Children Is Unduplicated) 276 1964.500000 140075.1500 71.3032
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Total 2078.500000 147320.5800 70.8783
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Number of Children (Unduplicated) With at Least One Service 308
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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 549 1852.000000 131357.8900 131357.8900
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 21 60.000000 4213.8800 4213.8800
58 144.500000 10137.8100 0.0000
Other 11 22.000000 1611.0000 0.0000
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Total 639 2078.500000 147320.5800 135571.7700