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: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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 40.1100 20.0550
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 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 8 14.000000 1050.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 20.000000 1333.1900 66.6595
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 36.000000 2623.0000 72.8611
Subtotal (Total Children Is Unduplicated) 39 77.000000 5421.3000 70.4065
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 162.500000 10112.3600 62.2299
PHY-97110-PT SESSION BY LICENSED PT 53 446.000000 29565.8400 66.2911
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 68 427.500000 27055.6800 63.2881
Subtotal (Total Children Is Unduplicated) 127 1039.000000 66883.8800 64.3733
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Total 1116.000000 72305.1800 64.7896
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Number of Children (Unduplicated) With at Least One Service 162
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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 1 1.500000 112.5000 0.0000
P 169 429.000000 23225.8000 23225.8000
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
230 647.000000 46079.3800 0.0000
Other 22 38.500000 2887.5000 0.0000
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Total 422 1116.000000 72305.1800 23225.8000