CMS/EIP Fiscal Report Center: 06
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: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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 45.500000 3412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 45.500000 2525.2500 55.5000
Subtotal (Total Children Is Unduplicated) 25 91.000000 5937.7500 65.2500
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 749 5683.500000 284175.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 37 122.750000 8769.2600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 12 45.500000 2574.0000 56.5714
PHY-97110-PT SESSION BY LICENSED PT 19 107.000000 7644.0600 71.4398
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 45 136.500000 9751.5600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 27.7600 13.8800
Subtotal (Total Children Is Unduplicated) 818 6097.250000 312941.6400 51.3250
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Total 6188.250000 318879.3900 51.5298
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Number of Children (Unduplicated) With at Least One Service 825
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Center 06
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 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
6407 6188.250000 318879.3900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6407 6188.250000 318879.3900 0.0000