CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 21.000000 1575.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 21.000000 1165.5000 55.5000
Subtotal (Total Children Is Unduplicated) 12 46.000000 3001.5000 65.2500
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 390 1964.250000 98212.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 52.000000 3714.8800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 6 17.750000 1015.3000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 35 75.500000 5393.7200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 13 28.000000 1600.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 40 129.250000 9233.6200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 481 2267.750000 119184.3800 52.5562
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Total 2313.750000 122185.8800 52.8086
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Number of Children (Unduplicated) With at Least One Service 487
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Center 06
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 0 0.000000 0.0000 0.0000
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
2501 2313.750000 122185.8800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2501 2313.750000 122185.8800 0.0000