CMS/EIP Fiscal Report Center: 57
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 2082 17511.61828 650648.4500 37.1552
Subtotal (Total Children Is Unduplicated) 2082 17511.61828 650648.4500 37.1552
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 36 61.000000 4575.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 14 25.000000 1875.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 13.500000 1012.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 59 109.000000 6049.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 721 1277.500000 95744.2500 74.9466
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 212 373.500000 27967.5000 74.8795
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 195 318.000000 23850.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1008 1834.000000 101787.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 114 200.500000 15037.5000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 1211 4227.000000 278928.8900 65.9874
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.000000 200.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 29.000000 2086.8400 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 2 5.000000 288.0000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 2 3.000000 215.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 9.000000 647.6400 71.9600
Subtotal (Total Children Is Unduplicated) 13 50.000000 3438.3600 68.7672
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Total 21788.618280 933015.7000 42.8212
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Number of Children (Unduplicated) With at Least One Service 2083
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Center 57
Flag Claims Units Chgs Paid
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R 25 44.500000 1954.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 4785 6949.750000 303470.9000 139.5000
P 9987 14794.368280 627590.6000 627065.2260
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 14797 21788.618280 933015.7000 627204.7260