CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92586-AUD EVOKED RESPONSE (LIMITED) 1 2.000000 59.0600 29.5300
EVAL-96111-DEVELOPMENTAL EVALUATION 1 1.500000 75.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 221.3500 55.3375
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 12.500000 937.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.500000 421.8000 49.6235
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 73.500000 4791.9200 65.1962
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 81 144.000000 7618.0900 52.9034
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 79 157.000000 11586.0000 73.7962
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 2.000000 58.2000 29.1000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 62.1000 31.0500
Subtotal (Total Children Is Unduplicated) 133 411.000000 26032.6700 63.3398
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 341 2173.750000 108425.0000 49.8792
INTR-T1013-INTERPRETER 6 12.500000 625.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 24 192.500000 11987.3100 62.2717
PHY-97110-PT SESSION BY LICENSED PT 41 302.500000 19761.4900 65.3272
PHY-97110HM-PT SESSION BY PT ASST 1 2.750000 175.0400 63.6509
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 78 461.250000 27427.0800 59.4625
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 27.7600 13.8800
Subtotal (Total Children Is Unduplicated) 421 3148.250000 168478.6800 53.5150
-----------------------------------------------------------------------------------------------------------------------
Total 3559.250000 194511.3500 54.6495
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 482
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 2718 2788.000000 149183.5900 149183.5900
D 70 69.250000 3256.6800 0.0000
S 71 76.000000 4072.4000 0.0000
H 150 191.500000 13866.4100 0.0000
T 235 235.000000 12628.6500 12567.2100
135 154.500000 8713.4200 0.0000
Other 34 45.000000 2790.2000 450.0000
---------------------------------------------------------
Total 3413 3559.250000 194511.3500 162200.8000