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
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
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 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 6.500000 487.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 154.2300 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 16 76.000000 3907.1600 51.4100
Subtotal (Total Children Is Unduplicated) 35 109.000000 6005.0500 55.0922
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 19 58.000000 2900.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 75 354.000000 25329.9200 71.5534
PHY-97110-PT SESSION BY LICENSED PT 107 705.000000 50333.0400 71.3944
PHY-97110GT-PT SESSION BY LICENSED PT 2 8.000000 575.6800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 158 1074.000000 76652.1200 71.3707
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 71.000000 5109.1600 71.9600
Subtotal (Total Children Is Unduplicated) 293 2270.000000 160899.9200 70.8810
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Total 2379.000000 166904.9700 70.1576
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Number of Children (Unduplicated) With at Least One Service 312
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Center 09
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 569 1948.000000 136566.6000 136554.6400
D 7 22.000000 1511.1600 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
132 398.000000 28177.7100 0.0000
Other 6 11.000000 649.5000 0.0000
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Total 714 2379.000000 166904.9700 136554.6400