CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 5 8.000000 490.0000 61.2500
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.000000 255.0000 63.7500
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 362.5000 65.9091
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 194.5200 35.3673
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 40.000000 2873.0800 71.8270
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 36.000000 2165.0400 60.1400
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.000000 730.0000 73.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 63 107.500000 5466.8200 50.8541
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 59.000000 3866.7800 65.5386
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 134 284.500000 16863.1900 59.2731
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 0.250000 0.0000 0.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 27.000000 1862.5200 68.9822
PHY-97110-PT SESSION BY LICENSED PT 6 18.000000 1128.7600 62.7089
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 83.000000 5649.6400 68.0680
Subtotal (Total Children Is Unduplicated) 30 128.250000 8640.9200 67.3756
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Total 412.750000 25504.1100 61.7907
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Number of Children (Unduplicated) With at Least One Service 158
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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 208 278.000000 16603.1800 16748.3900
D 16 20.000000 1399.7100 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
85 114.750000 7501.2200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 309 412.750000 25504.1100 16748.3900