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:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 954 4502.500000 166857.8500 37.0589
Subtotal (Total Children Is Unduplicated) 954 4502.500000 166857.8500 37.0589
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 19 36.500000 2737.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 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 20 40.000000 2220.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 262 519.250000 38943.7500 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 18.000000 1350.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 125 250.000000 18750.0000 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 47 93.500000 7012.5000 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 318 634.500000 35214.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
SCREEN-T1023-SCREENING 53 53.000000 2650.0000 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) 491 1798.750000 118001.7000 65.6021
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 243 2547.750000 127387.5000 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 60 490.500000 35119.2100 71.5988
Subtotal (Total Children Is Unduplicated) 300 3090.500000 165966.9500 53.7023
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Total 9391.750000 450826.5000 48.0024
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Number of Children (Unduplicated) With at Least One Service 971
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Center 52
Flag Claims Units Chgs Paid
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R 11 8.750000 451.9200 0.0000
U 0 0.000000 0.0000 0.0000
B 1857 1867.500000 101343.0200 55.8000
P 6648 6902.750000 321345.8600 441322.5300
D 40 58.750000 3645.7500 287.9000
S 515 452.750000 19714.0500 1758.4000
H 13 13.000000 847.6400 0.0000
T 1 1.000000 71.9600 0.0000
95 85.250000 3256.3000 0.0000
Other 1 2.000000 150.0000 150.0000
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Total 9181 9391.750000 450826.5000 443574.6300