CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 Page: 1
List order: No List
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 5 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 101 113.500000 8512.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 94 120.000000 6660.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 12.500000 937.5000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 510.5000 51.0500
Subtotal (Total Children Is Unduplicated) 120 278.500000 18017.2000 64.6937
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 308 2378.000000 118900.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 26.000000 1857.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 25 52.000000 3714.8800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 4.000000 228.6400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 33 165.500000 11812.6000 71.3752
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 15.000000 858.0000 57.2000
Subtotal (Total Children Is Unduplicated) 346 2640.500000 137371.5600 52.0248
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Total 2919.000000 155388.7600 53.2336
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Number of Children (Unduplicated) With at Least One Service 397
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Center 57
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 23 13.000000 908.3300 908.3300
D 0 0.000000 0.0000 0.0000
S 2 11.000000 550.0000 550.0000
H 0 0.000000 0.0000 0.0000
T 699 2336.000000 117621.8200 117621.8200
383 559.000000 36308.6100 19741.0200
Other 0 0.000000 0.0000 0.0000
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Total 1107 2919.000000 155388.7600 138821.1700