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
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
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 2 2.500000 93.0000 37.2000
Subtotal (Total Children Is Unduplicated) 2 2.500000 93.0000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 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 4 8.500000 637.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 16.500000 1237.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 13.000000 975.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 27 48.500000 2691.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 4.000000 211.7200 52.9300
Subtotal (Total Children Is Unduplicated) 41 102.500000 6614.4700 64.5314
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EI Services,Class #03
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 23 43.500000 2175.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 13 17.000000 850.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 48.000000 3454.0800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 5 9.000000 647.6400 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 21 80.750000 5774.7900 71.5144
PHY-97110GT-PT SESSION BY LICENSED PT 5 4.250000 305.8300 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 132.000000 9498.7200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 27.500000 1978.9000 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 3 3.000000 215.8800 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 0.500000 35.9800 71.9600
Subtotal (Total Children Is Unduplicated) 96 371.500000 25267.7000 68.0153
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Total 476.500000 31975.1700 67.1042
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Number of Children (Unduplicated) With at Least One Service 127
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Center 53
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 1 1.000000 71.9600 71.9600
D 82 101.750000 6190.9800 0.0000
S 1 2.000000 150.0000 0.0000
H 134 137.000000 9852.6000 0.0000
T 1 2.000000 111.0000 0.0000
218 230.750000 15454.7100 0.0000
Other 2 2.000000 143.9200 0.0000
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Total 439 476.500000 31975.1700 71.9600