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:EIP DEI DEIP
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 3.000000 180.0000 60.0000
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 1 1.000000 25.0000 25.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.000000 825.0000 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 36 55.500000 3742.5000 67.4324
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 19 31.500000 2225.0000 70.6349
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 31 52.000000 3257.5000 62.6442
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 138.1500 46.0500
Subtotal (Total Children Is Unduplicated) 126 268.500000 16702.5000 62.2067
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 11 51.000000 3643.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 26 193.250000 11825.8100 61.1944
Subtotal (Total Children Is Unduplicated) 37 244.250000 15469.2500 63.3337
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Total 512.750000 32171.7500 62.7435
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Number of Children (Unduplicated) With at Least One Service 159
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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 365 458.250000 28772.0800 28927.7600
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
41 49.500000 3042.4700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 411 512.750000 32171.7500 28983.4500