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: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-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 42 61.500000 3849.4700 62.5930
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 23 35.000000 2338.7900 66.8226
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 50 89.000000 4232.7800 47.5593
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 53.000000 3548.8300 66.9591
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) 122 261.000000 15413.2400 59.0546
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 6 11.000000 755.8400 68.7127
PHY-97110-PT SESSION BY LICENSED PT 3 9.000000 642.9600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 83.000000 5408.1200 65.1581
Subtotal (Total Children Is Unduplicated) 22 103.000000 6806.9200 66.0866
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Total 364.000000 22220.1600 61.0444
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Number of Children (Unduplicated) With at Least One Service 141
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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 204 279.500000 16599.4500 16670.0500
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
49 67.500000 4406.0700 74.4000
Other 0 0.000000 0.0000 0.0000
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Total 265 364.000000 22220.1600 16744.4500