CMS/EIP Fiscal Report Center: 52
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-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 20.000000 1200.0000 60.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 34.500000 2587.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 15.500000 1162.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 999.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 6.000000 300.0000 50.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 50 108.000000 7028.3500 65.0773
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 51 292.250000 14412.5000 49.3157
OCCT-97530-OT SESSION BY LICENSED OT 32 118.000000 7608.3600 64.4776
OCCT-97530HM-OT SESSION BY OT ASST 14 72.250000 3903.9000 54.0332
PHY-97110-PT SESSION BY LICENSED PT 20 113.250000 7233.3000 63.8702
PHY-97110HM-PT SESSION BY PT ASST 1 5.000000 285.8000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 83 550.250000 34533.2800 62.7593
Subtotal (Total Children Is Unduplicated) 172 1151.000000 67977.1400 59.0592
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Total 1259.000000 75005.4900 59.5754
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Number of Children (Unduplicated) With at Least One Service 196
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Center 52
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 409 835.500000 50263.4000 50263.4000
229 423.500000 24742.0900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 638 1259.000000 75005.4900 50263.4000