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
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-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 27.500000 2062.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 26.000000 1950.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.000000 333.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 35.000000 2625.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 4 9.000000 450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 53 105.500000 7570.5000 71.7583
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 26 155.000000 10528.7300 67.9273
PHY-97110-PT SESSION BY LICENSED PT 45 359.500000 25012.4800 69.5757
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 90 569.000000 38533.1800 67.7209
Subtotal (Total Children Is Unduplicated) 141 1083.500000 74074.3900 68.3658
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Total 1189.000000 81644.8900 68.6669
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Number of Children (Unduplicated) With at Least One Service 190
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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 204 513.000000 34043.6500 34043.6500
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 0 0.000000 0.0000 0.0000
203 621.500000 43630.7400 0.0000
Other 34 54.500000 3970.5000 0.0000
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Total 441 1189.000000 81644.8900 34043.6500