CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 1 1.500000 112.5000 75.0000
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 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 66.500000 4987.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 35.500000 2662.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 62.500000 4687.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 105 162.500000 9018.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 65 101.500000 7612.5000 75.0000
Subtotal (Total Children Is Unduplicated) 141 435.500000 29464.5000 67.6567
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 2176.5000 2176.5000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 11.000000 550.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 48 135.000000 9270.2600 68.6686
OCCT-97530HM-OT SESSION BY OT ASST 17 68.500000 3939.3200 57.5083
PHY-97110-PT SESSION BY LICENSED PT 48 203.000000 13523.1600 66.6166
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 121 542.750000 36777.9700 67.7623
Subtotal (Total Children Is Unduplicated) 211 962.250000 66308.6500 68.9100
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Total 1397.750000 95773.1500 68.5195
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Number of Children (Unduplicated) With at Least One Service 319
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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 645 379.250000 25257.2400 25257.2400
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
1354 1018.500000 70515.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1999 1397.750000 95773.1500 25257.2400