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: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-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 11.000000 825.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 7.000000 388.5000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 26.000000 1443.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 64 121.500000 9073.5000 74.6790
Subtotal (Total Children Is Unduplicated) 79 165.500000 11730.0000 70.8761
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 32 100.000000 5000.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 8.000000 571.5200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 11 36.000000 2571.8400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 36.000000 2571.8400 71.4400
Subtotal (Total Children Is Unduplicated) 55 180.000000 10715.2000 59.5289
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Total 345.500000 22445.2000 64.9644
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Number of Children (Unduplicated) With at Least One Service 127
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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 0 0.000000 0.0000 0.0000
D 1 1.000000 71.4400 0.0000
S 5 6.000000 345.7500 0.0000
H 147 187.000000 13528.9100 0.0000
T 0 0.000000 0.0000 0.0000
132 151.500000 8499.1000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 285 345.500000 22445.2000 0.0000