CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
Payclass Filters:MED
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 737 1917.250000 71321.7000 37.2000
Subtotal (Total Children Is Unduplicated) 737 1917.250000 71321.7000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
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 4 7.500000 416.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 67 120.500000 9037.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 57 107.500000 8062.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 39 72.500000 5512.5000 76.0345
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 109 198.500000 11016.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 18.500000 1387.5000 75.0000
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 123.3700 61.6850
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 5.000000 257.0500 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 149 540.500000 36427.3300 67.3956
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 639 3793.000000 189552.0000 49.9742
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 63 140.500000 7025.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 24 124.000000 8923.0400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 3 8.000000 575.6800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 31 222.000000 15975.1200 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 5.000000 359.8000 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 23 187.000000 13456.5200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 69.000000 4965.2400 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
Subtotal (Total Children Is Unduplicated) 706 4551.500000 241048.2800 52.9602
-----------------------------------------------------------------------------------------------------------------------
Total 7009.250000 348797.3100 49.7624
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1013
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
D 6 16.000000 909.8000 0.0000
S 0 0.000000 0.0000 0.0000
H 1879 2015.250000 83316.7500 83316.7500
T 0 0.000000 0.0000 0.0000
1567 4840.750000 255310.2100 130.2000
Other 72 137.250000 9260.5500 0.0000
---------------------------------------------------------
Total 3524 7009.250000 348797.3100 83446.9500