CMS/EIP Fiscal Report Center: 09
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 55 97.500000 7312.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 64 113.000000 8475.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 41.500000 2303.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 60.000000 4500.0000 75.0000
Subtotal (Total Children Is Unduplicated) 164 317.000000 22965.7500 72.4472
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 802 5610.000000 280200.0000 49.9465
OCCT-97530-OT SESSION BY LICENSED OT 42 312.000000 22289.2800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 66 491.000000 35077.0400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 130 924.000000 66010.5600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
Subtotal (Total Children Is Unduplicated) 944 7341.000000 403632.4000 54.9833
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Total 7658.000000 426598.1500 55.7062
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Number of Children (Unduplicated) With at Least One Service 1036
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Center 09
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
2387 7390.000000 406975.9000 0.0000
Other 159 268.000000 19622.2500 0.0000
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Total 2546 7658.000000 426598.1500 0.0000