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
Agency Filter:EIP DEI DEIP
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
EVAL-96111-DEVELOPMENTAL EVALUATION 4 5.000000 250.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 3.000000 150.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 8 12.102600 605.1300 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.833333 662.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 161 275.102531 20632.6900 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 21 33.996266 2549.7200 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.829866 212.2400 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.143782 285.4800 55.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 12 14.000000 719.7400 51.4100
Subtotal (Total Children Is Unduplicated) 208 360.008378 26067.5000 72.4080
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 171.700471 12347.3700 71.9123
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 0.750000 53.5800 71.4400
Subtotal (Total Children Is Unduplicated) 17 172.450471 12400.9500 71.9102
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Total 532.458849 38468.4500 72.2468
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Number of Children (Unduplicated) With at Least One Service 214
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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 0 0.000000 0.0000 0.0000
P 3 3.459733 259.4800 259.4800
D 0 0.000000 0.0000 0.0000
S 1 0.833333 62.5000 0.0000
H 140 213.665509 15509.9900 0.0000
T 0 0.000000 0.0000 0.0000
256 314.500274 22636.4800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 400 532.458849 38468.4500 259.4800