CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2017 ending 06/30/2018 Date of Report:08/10/2018 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
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 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 29 54.500000 4012.5000 73.6239
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 11.000000 825.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 68 127.500000 7076.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 40.000000 3000.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 221 372.013510 20591.2498 55.3508
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 106 168.000000 12561.0000 74.7679
Subtotal (Total Children Is Unduplicated) 361 780.013510 48590.9998 62.2951
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 362.5500 362.5500
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 7.000000 175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 580 7267.500000 363375.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 59.000000 4214.9600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 3 17.000000 972.4000 57.2000
Subtotal (Total Children Is Unduplicated) 592 7351.500000 369099.9100 50.2074
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Total 8131.513510 417690.9098 51.3669
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Number of Children (Unduplicated) With at Least One Service 747
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Center 53
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 1 1.000000 75.0000 75.0000
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 0 0.000000 0.0000 0.0000
7826 8130.513510 417615.9098 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7827 8131.513510 417690.9098 75.0000