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
Payclass Filters:TPIN
Eligibility Filter:Program Patients
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 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 45 85.000000 6375.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 35 62.000000 4650.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 20.500000 1537.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 74 138.500000 7686.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.500000 1012.5000 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) 135 374.500000 24277.1800 64.8256
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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 2 13.000000 935.4800 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 12 42.000000 3022.3200 71.9600
Subtotal (Total Children Is Unduplicated) 279 1979.500000 141154.5500 71.3082
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Total 2354.000000 165431.7300 70.2769
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Number of Children (Unduplicated) With at Least One Service 399
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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 557 1866.500000 132445.3900 132445.3900
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 23 64.000000 4474.8800 4474.8800
194 380.000000 25365.9600 0.0000
Other 22 43.500000 3145.5000 0.0000
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Total 796 2354.000000 165431.7300 136920.2700