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
Agency Filter:EXT
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 15 27.000000 2025.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 8.000000 450.0000 56.2500
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 228 444.000000 32250.0000 72.6351
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 74 154.000000 11100.0000 72.0779
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 16 32.000000 2400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 38.000000 2700.0000 71.0526
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 136 274.000000 15096.0000 55.0949
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 3.000000 154.2300 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 4 4.000000 205.2800 51.3200
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 5 5.000000 257.0500 51.4100
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 78 85.000000 4000.0000 47.0588
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 564.7900 51.3445
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 461.9700 51.3300
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 33.250000 1018.8625 30.6425
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.9300 52.9300
Subtotal (Total Children Is Unduplicated) 495 1169.250000 75192.4425 64.3083
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 71 89.750000 4463.4300 49.7318
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 113 143.500000 7175.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 55 49.250000 1231.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 101 281.750000 14068.7500 49.9335
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 4 4.250000 212.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 13 9.250000 231.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 59 120.250000 6012.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 7 5.750000 287.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 47 302.750000 15137.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 14 10.250000 512.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 35 61.750000 3087.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 466 4401.000000 218762.5000 49.7075
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 5.500000 275.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 779 9515.000000 95142.0000 9.9992
OCCT-97530-OT SESSION BY LICENSED OT 43 334.250000 23227.7900 69.4923
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.000000 215.8800 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 15 174.000000 10014.8000 57.5563
OCCT-97530TL-OT SESSION BY LICENSED OT 47 492.000000 35337.7600 71.8247
OCCT-97530TLGT-OT SESSION BY LICENSED OT 3 5.500000 394.7400 71.7709
OCCT-97530TLGTHM-OT SESSION BY OT ASST 3 5.750000 330.7000 57.5130
OCCT-97530TLHM-OT SESSION BY OT ASST 22 175.000000 10070.0000 57.5429
PHY-97110-PT SESSION BY LICENSED PT 56 461.250000 32991.4600 71.5262
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 143.9200 71.9600
PHY-97110HM-PT SESSION BY PT ASST 25 370.500000 20790.9400 56.1159
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 10 22.250000 1221.6500 54.9056
PHY-97110TL-PT SESSION BY LICENSED PT 43 411.750000 29587.1500 71.8571
PHY-97110TLGT-PT SESSION BY LICENSED PT 3 3.500000 250.5600 71.5886
PHY-97110TLGTHM-PT SESSION BY PT ASST 2 2.000000 115.1200 57.5600
PHY-97110TLHM-PT SESSION BY PT ASST 10 139.750000 8036.0100 57.5028
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 87 1052.630000 68605.2500 65.1751
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 73 820.000000 58919.4500 71.8530
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
TRAV-TRAVS-Travel by mile 519 54897.00000 24424.8500 0.4449
Subtotal (Total Children Is Unduplicated) 849 74380.63000 691683.1100 9.2992
-----------------------------------------------------------------------------------------------------------------------
Total 75549.880000 766875.5525 10.1506
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 986
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 10367 68614.130000 356848.2500 356564.2900
3694 6933.750000 409927.3025 409.8000
Other 1 2.000000 100.0000 100.0000
---------------------------------------------------------
Total 14062 75549.880000 766875.5525 357074.0900