CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.500000 860.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 17 27.500000 1526.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 37 68.000000 4077.6900 59.9660
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EI Services,Class #03
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 14 40.000000 2000.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 393 1655.500000 82557.0000 49.8683
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 35 101.500000 5075.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 38.000000 2626.5400 69.1195
OCCT-97530GT-OT SESSION BY LICENSED OT 3 7.000000 503.7200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 42 126.500000 9023.3600 71.3309
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 247.250000 17604.1200 71.1997
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 24.000000 1727.0400 71.9600
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 4.000000 55.8400 13.9600
Subtotal (Total Children Is Unduplicated) 473 2244.750000 121244.5800 54.0125
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Total 2312.750000 125322.2700 54.1876
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Number of Children (Unduplicated) With at Least One Service 497
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Center 01
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 1338 1354.750000 74250.9000 74250.9000
D 49 49.000000 2713.5200 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 904 909.000000 48357.8500 48482.2700
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2291 2312.750000 125322.2700 122733.1700