CMS/EIP Fiscal Report Center: 03
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
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
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.500000 337.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 48.500000 3456.6700 71.2715
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 40.000000 2722.7200 68.0680
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 31.500000 2362.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 37 70.000000 3885.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
Subtotal (Total Children Is Unduplicated) 91 219.500000 14326.7600 65.2700
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EI Services,Class #03
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 8 8.000000 400.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 80 147.500000 7375.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 202 697.000000 34850.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 5.000000 359.8000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 3.000000 215.8800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 5 6.000000 431.7600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 96.000000 5930.2400 61.7733
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 3.750000 269.8500 71.9600
TRAV-TRAVS-Travel by mile 1 36.000000 16.0200 0.4450
Subtotal (Total Children Is Unduplicated) 253 1003.250000 49858.5500 49.6970
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Total 1222.750000 64185.3100 52.4926
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Number of Children (Unduplicated) With at Least One Service 310
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Center 03
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 203 251.250000 11567.5700 11567.5700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 170 179.500000 9388.1000 9388.1000
T 0 0.000000 0.0000 0.0000
722 792.000000 43229.6400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1095 1222.750000 64185.3100 20955.6700