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
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
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.500000 337.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 11.000000 825.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 25.000000 1875.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 8.000000 600.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 57 89.000000 4939.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 40 64.000000 3552.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 69 132.000000 9900.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 78.000000 5850.0000 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 4 11.000000 565.5100 51.4100
Subtotal (Total Children Is Unduplicated) 170 445.500000 30056.4700 67.4668
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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 420 1757.000000 87632.0000 49.8759
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 40 105.500000 5275.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 21 93.750000 6638.3100 70.8086
OCCT-97530GT-OT SESSION BY LICENSED OT 5 9.000000 647.6400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 53 173.750000 12423.4700 71.5020
PHY-97110GT-PT SESSION BY LICENSED PT 4 4.000000 287.8400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 74 289.250000 20626.4400 71.3101
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 29.000000 2086.8400 71.9600
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 4.000000 55.8400 13.9600
Subtotal (Total Children Is Unduplicated) 513 2505.250000 137673.3800 54.9539
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Total 2950.750000 167729.8500 56.8431
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Number of Children (Unduplicated) With at Least One Service 650
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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 1352 1376.250000 75551.4000 75551.4000
D 50 50.000000 2763.5200 0.0000
S 1 1.000000 71.9600 0.0000
H 363 456.000000 30766.2400 0.0000
T 910 917.500000 48907.6000 49032.0200
125 150.000000 9669.1300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2801 2950.750000 167729.8500 124583.4200