CMS/EIP Fiscal Report Center: 51
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EVAL-96111GT-DEVELOPMENTAL EVALUATION 7 7.000000 350.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 26 26.000000 1950.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 79 80.500000 4440.0000 55.1553
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 16.500000 1237.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 10 10.000000 750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 6.000000 396.7900 66.1317
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 7.500000 562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 127 160.000000 8880.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 33 49.500000 2747.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 173 179.500000 13462.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 36.000000 2700.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 44 48.000000 2427.4300 50.5715
OCTH-97165GT-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 4 4.000000 205.6400 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 17 17.000000 873.6100 51.3888
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 23 25.000000 1284.1700 51.3668
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 16 17.000000 847.3100 49.8418
PSTH-97162-PT EVAL MODERATE COMPLEXITY 8 8.000000 411.2800 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 34 42.000000 1997.7200 47.5648
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.8700 51.2900
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
Subtotal (Total Children Is Unduplicated) 471 764.000000 46962.1300 61.4688
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 5.000000 391.5000 78.3000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 19 22.500000 1087.5000 48.3333
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 3.000000 150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 15 75.000000 3630.0000 48.4000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 207 3287.750000 163677.5000 49.7840
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 16 99.000000 4950.0000 50.0000
INTR-T1013-INTERPRETER 2 10.500000 315.0000 30.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 844 16434.00000 165780.0000 10.0876
OCCT-97530-OT SESSION BY LICENSED OT 252 2295.750000 158494.6300 69.0383
OCCT-97530GT-OT SESSION BY LICENSED OT 41 218.500000 13604.4600 62.2630
OCCT-97530HM-OT SESSION BY OT ASST 106 1148.500000 65859.9300 57.3443
OCCT-97530HMGT-OT SESSION BY OT ASST 15 42.500000 2448.0000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 2 3.750000 269.8500 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 4.000000 285.7600 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 5 10.250000 587.1000 57.2780
OCCT-97530TLHM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 72 1209.500000 84957.2300 70.2416
PHY-97110GT-PT SESSION BY LICENSED PT 4 17.000000 1221.7600 71.8682
PHY-97110TL-PT SESSION BY LICENSED PT 2 39.750000 2859.2400 71.9306
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 292 4742.250000 332885.9500 70.1958
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 24 158.000000 11124.8900 70.4107
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
Subtotal (Total Children Is Unduplicated) 868 29833.50000 1015003.2600 34.0223
-----------------------------------------------------------------------------------------------------------------------
Total 30597.500000 1061965.3900 34.7076
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 978
-----------------------------------------------------------------------------------------------------------------------
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.500000 138.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 40 55.000000 3453.7500 0.0000
P 8126 24367.000000 680652.3000 680452.3000
D 1 4.000000 251.8600 251.8600
S 0 0.000000 0.0000 0.0000
H 3 14.000000 964.3600 964.3600
T 0 0.000000 0.0000 0.0000
2062 6155.000000 376504.3700 100.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10234 30597.500000 1061965.3900 681768.5200