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:EIP DEI DEIP
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 416 948.750000 35172.6000 37.0726
Subtotal (Total Children Is Unduplicated) 416 948.750000 35172.6000 37.0726
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 48 93.000000 6975.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 42.000000 3150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 34.000000 2550.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 65 130.000000 7215.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
SCREEN-T1023-SCREENING 8 8.000000 400.0000 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 2 10.000000 514.1000 51.4100
Subtotal (Total Children Is Unduplicated) 105 368.000000 24332.5100 66.1210
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 144 674.500000 33725.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 17 69.500000 3500.0000 50.3597
OCCT-97530TL-OT SESSION BY LICENSED OT 4 10.250000 737.5900 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 4 8.000000 460.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 3 3.000000 215.8800 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 12 44.000000 3166.2400 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 7 34.000000 2446.6400 71.9600
Subtotal (Total Children Is Unduplicated) 169 843.250000 44252.1500 52.4781
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Total 2160.000000 103757.2600 48.0358
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Number of Children (Unduplicated) With at Least One Service 462
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Center 52
Flag Claims Units Chgs Paid
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R 44 41.250000 2184.6600 0.0000
U 0 0.000000 0.0000 0.0000
B 610 623.500000 32054.2400 109.1600
P 1284 1258.000000 59629.5600 59465.2200
D 0 0.000000 0.0000 0.0000
S 186 181.250000 7555.5000 180.0200
H 0 0.000000 0.0000 0.0000
T 1 0.500000 18.6000 0.0000
65 55.500000 2314.7000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2190 2160.000000 103757.2600 59754.4000