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: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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 22.000000 1050.0000 47.7273
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 22.000000 777.0000 35.3182
Subtotal (Total Children Is Unduplicated) 12 44.000000 1827.0000 41.5227
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 295 2303.250000 115162.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 70 249.500000 17283.1900 69.2713
OCCT-97530HM-OT SESSION BY OT ASST 27 119.250000 6797.7400 57.0041
PHY-97110-PT SESSION BY LICENSED PT 44 220.000000 13685.9300 62.2088
PHY-97110HM-PT SESSION BY PT ASST 1 0.500000 3.5800 7.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 195 1038.250000 68769.9100 66.2364
Subtotal (Total Children Is Unduplicated) 519 3931.750000 221752.8500 56.4005
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Total 3975.750000 223579.8500 56.2359
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Number of Children (Unduplicated) With at Least One Service 523
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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 2588 2173.750000 119661.7800 119661.7800
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
2382 1802.000000 103918.0700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4970 3975.750000 223579.8500 119661.7800