CMS/EIP Fiscal Report Center: 52
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 6.000000 300.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 20.000000 1115.5400 55.7770
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 23 40.000000 2178.1400 54.4535
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EI Services,Class #03
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 5.000000 207.0000 41.4000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 51 322.250000 16012.5000 49.6897
OCCT-97530-OT SESSION BY LICENSED OT 24 131.750000 9150.8200 69.4559
OCCT-97530HM-OT SESSION BY OT ASST 4 6.500000 371.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 22 161.500000 10001.4600 61.9285
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 81 516.250000 35174.1400 68.1339
Subtotal (Total Children Is Unduplicated) 151 1143.250000 70917.7200 62.0317
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Total 1183.250000 73095.8600 61.7755
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Number of Children (Unduplicated) With at Least One Service 162
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Center 52
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 393 942.500000 58912.3900 58912.3900
123 240.750000 14183.4700 128.0500
Other 0 0.000000 0.0000 0.0000
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Total 516 1183.250000 73095.8600 59040.4400