CMS/EIP Fiscal Report Center: 52
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:MED
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 30.000000 2250.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 24 47.000000 3240.0500 68.9372
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 128 530.750000 26537.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 2 2.000000 115.2000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 14 54.000000 3885.8400 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 2 2.000000 115.2000 57.6000
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.5600 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 9 32.000000 2302.7200 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 6 22.000000 1266.3200 57.5600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 36 137.500000 9894.5000 71.9600
Subtotal (Total Children Is Unduplicated) 185 783.250000 44318.7600 56.5832
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Total 830.250000 47558.8100 57.2825
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Number of Children (Unduplicated) With at Least One Service 205
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Center 52
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 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
819 830.250000 47558.8100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 819 830.250000 47558.8100 0.0000