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
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 29.500000 2212.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 29.000000 2175.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 31.500000 2290.5000 72.7143
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 50 107.000000 7905.1000 73.8794
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 17 119.500000 6986.8300 58.4672
PHY-97110-PT SESSION BY LICENSED PT 42 299.500000 20682.7700 69.0577
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 71 520.000000 35439.2500 68.1524
Subtotal (Total Children Is Unduplicated) 116 939.000000 63108.8500 67.2086
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Total 1046.000000 71013.9500 67.8910
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Number of Children (Unduplicated) With at Least One Service 163
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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 151 420.500000 26752.9500 26752.9500
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
184 546.500000 38336.0000 0.0000
Other 48 79.000000 5925.0000 0.0000
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Total 383 1046.000000 71013.9500 26752.9500