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: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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 25.500000 1912.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 25.500000 1415.2500 55.5000
Subtotal (Total Children Is Unduplicated) 14 51.000000 3327.7500 65.2500
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 41.000000 2050.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 37 115.750000 8125.1100 70.1953
OCCT-97530HM-OT SESSION BY OT ASST 20 61.500000 3482.9000 56.6325
PHY-97110-PT SESSION BY LICENSED PT 45 187.500000 12342.0200 65.8241
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 133 620.250000 41925.3200 67.5942
Subtotal (Total Children Is Unduplicated) 201 1026.000000 67925.3500 66.2040
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Total 1077.000000 71253.1000 66.1589
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Number of Children (Unduplicated) With at Least One Service 215
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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 856 525.750000 35179.0100 35179.0100
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
884 551.250000 36074.0900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1740 1077.000000 71253.1000 35179.0100