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
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 18.500000 1387.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 27.500000 1526.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 10.500000 787.5000 75.0000
Subtotal (Total Children Is Unduplicated) 17 56.500000 3701.2500 65.5089
-----------------------------------------------------------------------------------------------------------------------
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
-----------------------------------------------------------------------------------------------------------------------
Total 1018.750000 70009.9000 68.7214
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 228
-----------------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
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
1107 639.500000 44752.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1752 1018.750000 70009.9000 25257.2400