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: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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 52 81.500000 5257.9200 64.5144
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 44.500000 2875.4500 64.6169
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 54 93.500000 4464.1300 47.7447
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 44.000000 2808.6000 63.8318
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 389.4500 43.2722
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 97.8800 48.9400
Subtotal (Total Children Is Unduplicated) 144 299.000000 17596.1300 58.8499
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 14 91.000000 6382.1100 70.1331
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 151.000000 10042.3700 66.5058
Subtotal (Total Children Is Unduplicated) 38 242.000000 16424.4800 67.8698
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Total 541.000000 34020.6100 62.8847
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Number of Children (Unduplicated) With at Least One Service 170
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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 206 254.000000 15416.7600 15538.5700
D 11 11.000000 785.8400 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
211 276.000000 17818.0100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 428 541.000000 34020.6100 15538.5700