CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 28.000000 1679.9300 59.9975
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 29.000000 1529.5000 52.7414
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 18.500000 1387.5000 75.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 10.5500 10.5500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 38 81.000000 4873.1300 60.1621
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 1710.1600 570.0533
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 315 2025.750000 101283.9400 49.9982
INTR-T1013-INTERPRETER 2 4.500000 225.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 17 139.500000 9495.8300 68.0705
PHY-97110-PT SESSION BY LICENSED PT 16 86.000000 5162.5800 60.0300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 359.250000 21780.4800 60.6276
Subtotal (Total Children Is Unduplicated) 380 2618.000000 139657.9900 53.3453
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Total 2699.000000 144531.1200 53.5499
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Number of Children (Unduplicated) With at Least One Service 400
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Center 01
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 2531 2537.000000 135072.7700 135072.7700
D 24 24.000000 1353.2500 0.0000
S 27 28.000000 1473.2300 0.0000
H 0 0.000000 0.0000 0.0000
T 103 101.000000 5956.8700 5956.8700
1 1.500000 112.5000 0.0000
Other 5 7.500000 562.5000 0.0000
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Total 2691 2699.000000 144531.1200 141029.6400