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
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
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 4 6.500000 333.0000 51.2308
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 33.500000 2189.2800 65.3516
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 44.5100 22.2550
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 54.000000 2886.0000 53.4444
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 20.500000 1462.5000 71.3415
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) 56 124.500000 7416.9400 59.5738
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.000000 3348.1200 837.0300
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 234 1494.500000 74700.0000 49.9833
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 97.500000 6579.9600 67.4868
PHY-97110-PT SESSION BY LICENSED PT 23 129.250000 7254.6200 56.1286
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 87 504.750000 33160.6400 65.6972
Subtotal (Total Children Is Unduplicated) 314 2233.000000 125129.3400 56.0364
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Total 2357.500000 132546.2800 56.2232
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Number of Children (Unduplicated) With at Least One Service 349
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Center 01
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 1995 2014.250000 111865.6100 111865.6100
D 244 243.500000 14419.0400 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 55.5000 0.0000
T 68 66.750000 3975.4400 3975.4400
4 8.000000 561.0000 0.0000
Other 15 24.000000 1669.6900 0.0000
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Total 2327 2357.500000 132546.2800 115841.0500