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
Payclass Filters:MED
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 5 10.000000 750.0000 75.0000
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 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 75 150.000000 11250.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 16.000000 1200.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 63 126.000000 6993.0000 55.5000
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-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-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
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 40 41.000000 2050.0000 50.0000
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 461.9700 51.3300
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.9300 52.9300
Subtotal (Total Children Is Unduplicated) 190 379.000000 24299.6400 64.1151
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 295 2749.500000 137425.0000 49.9818
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 4.500000 225.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 51.000000 3669.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 3.000000 172.8000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 47 489.000000 35122.4000 71.8249
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 5 9.250000 662.7700 71.6508
PHY-97110HM-PT SESSION BY PT ASST 3 6.000000 345.3600 57.5600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 1.000000 57.5600 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 43 410.250000 29479.2100 71.8567
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 7 16.000000 1151.3600 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
Subtotal (Total Children Is Unduplicated) 428 4892.000000 286499.4400 58.5649
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Total 5271.000000 310799.0800 58.9640
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Number of Children (Unduplicated) With at Least One Service 509
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Center 52
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 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 1 2.000000 143.9200 0.0000
2735 5269.000000 310655.1600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2736 5271.000000 310799.0800 0.0000