CMS/EIP Fiscal Report Center: 52
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1044 4523.500000 167623.2500 37.0561
Subtotal (Total Children Is Unduplicated) 1044 4523.500000 167623.2500 37.0561
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 35.500000 2662.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 46.000000 2553.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 306 606.250000 45468.7500 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 17.500000 1312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 133 265.500000 19912.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 63 125.000000 9375.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 378 753.000000 41791.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.500000 860.2500 55.5000
SCREEN-T1023-SCREENING 52 52.000000 2600.0000 50.0000
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 18 18.000000 925.0200 51.3900
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.5700 52.5700
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 12 77.000000 4068.6100 52.8391
Subtotal (Total Children Is Unduplicated) 574 2054.250000 134732.2000 65.5871
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 242 2474.250000 123712.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 9 9.250000 462.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 12.000000 859.8800 71.6567
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 4.000000 230.4000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 1 8.000000 575.6800 71.9600
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 17.000000 1202.7400 70.7494
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 60 480.500000 34399.6100 71.5913
Subtotal (Total Children Is Unduplicated) 299 3007.000000 161572.3500 53.7321
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Total 9584.750000 463927.8000 48.4027
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Number of Children (Unduplicated) With at Least One Service 1067
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Center 52
Flag Claims Units Chgs Paid
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R 13 13.000000 685.6200 0.0000
U 0 0.000000 0.0000 0.0000
B 1969 2018.750000 108979.3200 130.2000
P 7117 7553.000000 354262.8600 474129.2400
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9099 9584.750000 463927.8000 474259.4400