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: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-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 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 34 54.000000 3716.3600 68.8215
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 42 70.500000 3912.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 25.500000 1912.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 29.5600 29.5600
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 73 159.000000 10036.3700 63.1218
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 103.0600 103.0600
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 59.0000 59.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 326 2171.750000 108437.5000 49.9309
INTR-T1013-INTERPRETER 1 3.000000 150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 25 156.250000 10253.5000 65.6224
PHY-97110-PT SESSION BY LICENSED PT 17 96.750000 5372.9900 55.5348
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 73 379.500000 23323.7200 61.4591
Subtotal (Total Children Is Unduplicated) 396 2811.250000 147799.7700 52.5744
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Total 2970.250000 157836.1400 53.1390
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Number of Children (Unduplicated) With at Least One Service 427
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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 2714 2738.750000 144145.5200 144145.5200
D 35 35.000000 1872.4400 0.0000
S 57 56.000000 3443.4800 0.0000
H 0 0.000000 0.0000 0.0000
T 123 117.000000 6748.7000 6748.7000
1 1.000000 75.0000 0.0000
Other 14 22.500000 1551.0000 0.0000
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Total 2944 2970.250000 157836.1400 150894.2200