CMS/EIP Fiscal Report Center: 06
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 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 35.500000 2662.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 35.500000 1970.2500 55.5000
Subtotal (Total Children Is Unduplicated) 23 81.000000 5285.2500 65.2500
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 715 5174.000000 258660.0000 49.9923
OCCT-97530-OT SESSION BY LICENSED OT 41 132.250000 9447.9400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 10 29.500000 1687.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 16 60.000000 4286.4000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 4 7.000000 400.1200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 40 157.500000 11251.8000 71.4400
Subtotal (Total Children Is Unduplicated) 780 5560.250000 285733.6600 51.3886
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Total 5641.250000 291018.9100 51.5877
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Number of Children (Unduplicated) With at Least One Service 787
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Center 06
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 0 0.000000 0.0000 0.0000
5860 5641.250000 291018.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5860 5641.250000 291018.9100 0.0000