CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2023 ending 09/30/2023 Date of Report:10/10/2023 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 594 1401.500000 52061.4000 37.1469
Subtotal (Total Children Is Unduplicated) 594 1401.500000 52061.4000 37.1469
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 49 83.500000 6262.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 30 53.000000 3975.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 22 34.500000 2587.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 71 122.000000 6771.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 34.000000 2550.0000 75.0000
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 10.000000 514.1000 51.4100
Subtotal (Total Children Is Unduplicated) 161 363.500000 24423.3500 67.1894
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 122 370.250000 18512.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 68 130.500000 6525.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 7.000000 503.7200 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 29 60.500000 4353.5800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 12 25.000000 1799.0000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 1 3.000000 215.8800 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 50 266.750000 19195.3300 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 12 12.750000 917.4900 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 3.000000 215.8800 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 5.000000 359.8000 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 38 92.000000 6620.3200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 26 48.750000 3508.0500 71.9600
Subtotal (Total Children Is Unduplicated) 264 1026.500000 62870.4700 61.2474
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Total 2791.500000 139355.2200 49.9213
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Number of Children (Unduplicated) With at Least One Service 683
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Center 53
Flag Claims Units Chgs Paid
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R 80 64.750000 3757.9500 0.0000
U 0 0.000000 0.0000 0.0000
B 736 671.250000 34949.1800 0.0000
P 2229 2055.500000 100648.0900 100632.5300
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3045 2791.500000 139355.2200 100632.5300