CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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 4 7.000000 480.0000 68.5714
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.500000 437.5000 67.3077
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 16.500000 1237.5000 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 54 85.000000 5955.0000 70.0588
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 27.500000 1947.5000 70.8182
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 60.500000 4400.0000 72.7273
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 45 79.000000 4049.8000 51.2633
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 51 83.500000 5548.0000 66.4431
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 189.2000 47.3000
Subtotal (Total Children Is Unduplicated) 129 375.500000 24607.6000 65.5329
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 28 170.500000 10630.2700 62.3476
PHY-97110-PT SESSION BY LICENSED PT 42 299.500000 20682.7700 69.0577
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 96 713.250000 47265.0600 66.2672
Subtotal (Total Children Is Unduplicated) 152 1183.250000 78578.1000 66.4087
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Total 1558.750000 103185.7000 66.1977
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Number of Children (Unduplicated) With at Least One Service 262
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Center 09
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 516 878.750000 55525.0300 55680.7100
D 4 4.000000 285.7600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 71.4400 55.6900
225 596.000000 41378.4700 0.0000
Other 48 79.000000 5925.0000 0.0000
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Total 794 1558.750000 103185.7000 55736.4000