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
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
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 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 33.3000 22.2000
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 66 118.000000 6175.0900 52.3313
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 35.500000 2512.5000 70.7746
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) 102 245.500000 14302.6700 58.2593
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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 311 2073.750000 103425.0000 49.8734
INTR-T1013-INTERPRETER 6 12.500000 625.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 184.500000 11415.7900 61.8742
PHY-97110-PT SESSION BY LICENSED PT 30 266.500000 17189.6500 64.5015
PHY-97110HM-PT SESSION BY PT ASST 1 2.750000 175.0400 63.6509
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 65 425.250000 24855.2400 58.4485
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 27.7600 13.8800
Subtotal (Total Children Is Unduplicated) 379 2968.250000 157763.4800 53.1503
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Total 3213.750000 172066.1500 53.5406
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Number of Children (Unduplicated) With at Least One Service 426
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Center 01
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 2718 2788.000000 149183.5900 149183.5900
D 69 68.250000 3185.2400 0.0000
S 66 70.000000 3726.6500 0.0000
H 3 4.500000 337.5000 0.0000
T 235 235.000000 12628.6500 12567.2100
3 3.000000 214.3200 0.0000
Other 34 45.000000 2790.2000 450.0000
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Total 3128 3213.750000 172066.1500 162200.8000