CMS/EIP Fiscal Report Center: 55
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1499 10837.75000 401125.0000 37.0118
Subtotal (Total Children Is Unduplicated) 1499 10837.75000 401125.0000 37.0118
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 41 84.000000 6300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC 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 3 6.000000 333.0000 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 645 1287.160000 96537.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 93 186.000000 13950.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 282 574.000000 31857.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 47 94.000000 5217.0000 55.5000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92521TL-EVAL OF SPEECH FLUENCY 2 3.000000 154.2300 51.4100
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 5.000000 255.9700 51.1940
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 5.000000 257.0500 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
Subtotal (Total Children Is Unduplicated) 819 2263.160000 156169.9300 69.0053
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 52 649.500000 32475.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 22.000000 1100.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 70.000000 5028.2300 71.8319
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 4.750000 341.8100 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 19 253.000000 18180.9200 71.8613
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 6.250000 449.3600 71.8976
Subtotal (Total Children Is Unduplicated) 84 1005.500000 57575.3200 57.2604
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Total 14106.410000 614870.2500 43.5880
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Number of Children (Unduplicated) With at Least One Service 1531
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Center 55
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 3824 3868.703067 177195.0800 0.0000
P 10289 10237.706933 437675.1700 437140.5600
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 14113 14106.410000 614870.2500 437140.5600