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: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
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 29.500000 2212.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 43.500000 3262.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 14 65.000000 3250.0000 50.0000
Subtotal (Total Children Is Unduplicated) 44 142.500000 9062.5000 63.5965
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 19 73.000000 5215.1200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 39 215.000000 15270.8700 71.0273
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 69 357.500000 25539.8000 71.4400
Subtotal (Total Children Is Unduplicated) 109 645.500000 46025.7900 71.3025
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Total 788.000000 55088.2900 69.9090
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Number of Children (Unduplicated) With at Least One Service 152
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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 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
280 759.500000 52950.7900 0.0000
Other 18 28.500000 2137.5000 0.0000
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Total 298 788.000000 55088.2900 0.0000