CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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 6 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 96 129.500000 9712.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 150 239.500000 13292.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 59.500000 4462.5000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 206 442.000000 28397.3000 64.2473
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 39 124.500000 6225.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 26.000000 1857.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 3.500000 247.0400 70.5829
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 15.000000 483.2100 32.2140
Subtotal (Total Children Is Unduplicated) 50 169.000000 8812.6900 52.1461
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Total 611.000000 37209.9900 60.9001
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Number of Children (Unduplicated) With at Least One Service 254
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Center 01
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 123 125.500000 6117.6200 0.0000
S 102 131.500000 8257.1200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 242 354.000000 22835.2500 0.0000
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Total 467 611.000000 37209.9900 0.0000