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: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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 38.000000 2850.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 18.500000 1350.0000 72.9730
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 66.000000 3663.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 28.500000 2137.5000 75.0000
Subtotal (Total Children Is Unduplicated) 78 163.000000 10871.2500 66.6948
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 9.000000 450.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 39.000000 2768.3000 70.9821
PHY-97110-PT SESSION BY LICENSED PT 4 10.000000 714.4000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 82.000000 5758.0800 70.2205
Subtotal (Total Children Is Unduplicated) 31 140.000000 9690.7800 69.2199
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Total 303.000000 20562.0300 67.8615
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Number of Children (Unduplicated) With at Least One Service 109
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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 74 74.500000 5298.3700 5456.7700
D 6 9.000000 599.6300 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
163 219.500000 14664.0300 71.4600
Other 0 0.000000 0.0000 0.0000
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Total 243 303.000000 20562.0300 5528.2300