CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 30.000000 2250.0000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 19 36.000000 2652.1000 73.6694
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 13 45.250000 3232.6600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 11 49.750000 2623.0100 52.7238
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 40 290.250000 20192.1400 69.5681
Subtotal (Total Children Is Unduplicated) 60 386.250000 26065.8100 67.4843
-----------------------------------------------------------------------------------------------------------------------
Total 422.250000 28717.9100 68.0116
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 72
-----------------------------------------------------------------------------------------------------------------------
Center 02
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 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 407 376.750000 25599.7200 25181.5100
47 45.500000 3118.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 454 422.250000 28717.9100 25181.5100