CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 27.500000 2007.5000 73.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 18.500000 1387.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 11.500000 862.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.500000 187.5000 75.0000
Subtotal (Total Children Is Unduplicated) 33 60.000000 4445.0000 74.0833
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 45.000000 3214.8000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 20 95.000000 6745.7400 71.0078
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 77.000000 5500.8800 71.4400
Subtotal (Total Children Is Unduplicated) 43 219.000000 15561.4200 71.0567
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Total 279.000000 20006.4200 71.7076
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Number of Children (Unduplicated) With at Least One Service 76
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Center 09
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 1 1.000000 71.4400 0.0000
P 112 112.000000 7958.4000 7958.4000
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
146 166.000000 11976.5800 203.2200
Other 0 0.000000 0.0000 0.0000
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Total 259 279.000000 20006.4200 8161.6200