CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 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
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.500000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1 0.500000 0.0000 0.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 36.500000 2737.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 28.000000 2100.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 9.000000 675.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
Subtotal (Total Children Is Unduplicated) 50 81.500000 6083.2500 74.6411
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 11 53.000000 3786.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 17 70.000000 5000.8000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 90.000000 6258.0000 69.5333
Subtotal (Total Children Is Unduplicated) 42 213.000000 15045.1200 70.6344
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Total 295.000000 21128.3700 71.6216
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Number of Children (Unduplicated) With at Least One Service 92
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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 0 0.000000 0.0000 0.0000
P 164 164.500000 11764.3400 270829.0300
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
108 130.500000 9364.0300 300.5400
Other 0 0.000000 0.0000 0.0000
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Total 272 295.000000 21128.3700 271129.5700