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: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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 8.000000 450.0000 56.2500
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 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 67 148.000000 10050.0000 67.9054
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 64 134.000000 9600.0000 71.6418
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 13 26.000000 1950.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 20.000000 1350.0000 67.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 67 136.000000 7437.0000 54.6838
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-97166-OT EVAL MODERATE COMPLEXITY 1 2.000000 102.8200 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-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-97163-PT EVAL HIGH COMPLEXITY 4 4.000000 205.2800 51.3200
SCREEN-T1023-SCREENING 37 43.000000 1900.0000 44.1860
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 513.3800 51.3380
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 33.250000 1018.8625 30.6425
Subtotal (Total Children Is Unduplicated) 216 593.250000 36400.3925 61.3576
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.250000 12.5000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 188 1593.500000 78437.5000 49.2234
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 2.000000 20.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 28 270.250000 18622.3500 68.9079
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.000000 215.8800 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 14 170.000000 9784.4000 57.5553
PHY-97110-PT SESSION BY LICENSED PT 51 449.500000 32149.3100 71.5224
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 143.9200 71.9600
PHY-97110HM-PT SESSION BY PT ASST 21 352.500000 20006.5600 56.7562
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 9 20.250000 1156.3100 57.1017
PHY-97110TL-PT SESSION BY LICENSED PT 1 1.500000 107.9400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 77 1004.880000 65169.1600 64.8527
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 316 3873.630000 226047.7900 58.3555
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Total 4466.880000 262448.1825 58.7542
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Number of Children (Unduplicated) With at Least One Service 419
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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 1630 3022.130000 175247.3600 175229.3600
848 1444.750000 87200.8225 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2478 4466.880000 262448.1825 175229.3600