CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 24.000000 1800.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 66 102.500000 7687.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 7.500000 416.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 51 70.000000 5225.0000 74.6429
Subtotal (Total Children Is Unduplicated) 133 216.500000 16066.2500 74.2090
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 653 4783.000000 239150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 48 442.000000 31576.4800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 76 582.000000 41578.0800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 76 632.000000 45150.0800 71.4400
Subtotal (Total Children Is Unduplicated) 767 6439.000000 357454.6400 55.5140
-----------------------------------------------------------------------------------------------------------------------
Total 6655.500000 373520.8900 56.1221
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 814
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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
2004 6445.500000 357942.1400 0.0000
Other 140 210.000000 15578.7500 0.0000
---------------------------------------------------------
Total 2144 6655.500000 373520.8900 0.0000