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:Program Patients
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 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 80 118.000000 8001.9700 67.8133
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 19.500000 1345.0200 68.9754
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 53 83.000000 5938.7900 71.5517
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 69 121.000000 5938.7800 49.0808
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 80 123.500000 8675.3300 70.2456
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) 184 494.500000 31657.4900 64.0192
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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 1681.000000 112538.8000 66.9475
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Number of Children (Unduplicated) With at Least One Service 331
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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 456 866.000000 55376.8500 55447.4500
D 13 18.500000 1327.1400 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
261 702.500000 48901.8100 74.4000
Other 62 94.000000 6933.0000 0.0000
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Total 792 1681.000000 112538.8000 55521.8500