CMS/EIP Fiscal Report Center: 54
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 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 19.500000 1082.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 29 59.000000 3274.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 26.500000 1987.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 73 153.000000 11475.0000 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 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 17 33.500000 2512.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 57 103.500000 5744.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 261 502.500000 27888.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.000000 600.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 63.000000 4725.0000 75.0000
Subtotal (Total Children Is Unduplicated) 438 997.500000 61464.7500 61.6188
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 470 4981.500000 248986.0000 49.9821
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 372 1933.250000 96622.5000 49.9793
OCCT-97530TL-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 16 84.000000 6040.4800 71.9105
PHY-97110GT-PT SESSION BY LICENSED PT 4 11.000000 789.4800 71.7709
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 36 381.000000 27409.4800 71.9409
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 17.000000 1222.2800 71.8988
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 215.8800 71.9600
Subtotal (Total Children Is Unduplicated) 632 7412.750000 381430.0200 51.4559
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Total 8410.250000 442894.7700 52.6613
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Number of Children (Unduplicated) With at Least One Service 850
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Center 54
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 1 1.000000 50.0000 50.0000
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 0 0.000000 0.0000 0.0000
7971 8409.250000 442844.7700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7972 8410.250000 442894.7700 50.0000