CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 58 89.000000 5911.9700 66.4266
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 15.000000 1042.5200 69.5013
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 61.000000 4288.7900 70.3080
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 54 95.000000 4565.7800 48.0608
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 88.000000 6173.8300 70.1572
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 4 9.000000 450.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 134 366.500000 22983.7400 62.7114
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 32 166.000000 11284.5700 67.9793
PHY-97110-PT SESSION BY LICENSED PT 48 368.500000 25655.4400 69.6213
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 105 652.000000 43941.3000 67.3946
Subtotal (Total Children Is Unduplicated) 161 1186.500000 80881.3100 68.1680
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Total 1553.000000 103865.0500 66.8803
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Number of Children (Unduplicated) With at Least One Service 281
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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 408 792.500000 50643.1000 50713.7000
D 12 17.000000 1214.6400 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
252 689.000000 48036.8100 74.4000
Other 34 54.500000 3970.5000 0.0000
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Total 706 1553.000000 103865.0500 50788.1000