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: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
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 20 38.000000 2850.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 14 26.500000 1987.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 42 81.500000 4523.2500 55.5000
Subtotal (Total Children Is Unduplicated) 66 163.000000 10518.7500 64.5322
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EI Services,Class #03
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 13.000000 935.4800 71.9600
Subtotal (Total Children Is Unduplicated) 3 15.000000 1079.4000 71.9600
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Total 178.000000 11598.1500 65.1581
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Number of Children (Unduplicated) With at Least One Service 69
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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
99 176.000000 11448.1500 0.0000
Other 1 2.000000 150.0000 0.0000
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Total 100 178.000000 11598.1500 0.0000