CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 11.000000 825.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 11.500000 862.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 8.000000 416.2500 52.0313
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 44 71.000000 5001.7800 70.4476
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 30.000000 2144.5100 71.4837
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 48 83.000000 4495.5000 54.1627
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 40.500000 2962.5000 73.1481
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 109 265.500000 17397.1900 65.5261
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.000000 3348.1200 837.0300
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.000000 100.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 8.500000 425.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 250 1553.500000 77650.0000 49.9839
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 25 105.500000 7151.4800 67.7865
PHY-97110-PT SESSION BY LICENSED PT 35 175.250000 10540.8600 60.1476
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 126 672.750000 45162.5600 67.1313
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.000000 23.8800 11.9400
Subtotal (Total Children Is Unduplicated) 368 2529.500000 144612.9000 57.1705
-----------------------------------------------------------------------------------------------------------------------
Total 2795.000000 162010.0900 57.9643
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 421
-----------------------------------------------------------------------------------------------------------------------
Center 01
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 1995 2014.250000 111865.6100 111865.6100
D 247 248.000000 14663.2900 0.0000
S 0 0.000000 0.0000 0.0000
H 260 280.000000 19178.0600 0.0000
T 68 66.750000 3975.4400 3975.4400
134 162.000000 10658.0000 0.0000
Other 15 24.000000 1669.6900 0.0000
---------------------------------------------------------
Total 2719 2795.000000 162010.0900 115841.0500