CMS/EIP Fiscal Report Center: 09
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-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 51 84.500000 5587.3500 66.1225
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 38.500000 2804.5000 72.8442
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 30.000000 2250.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 52 94.500000 5184.7500 54.8651
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 88.000000 6291.2500 71.4915
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
Subtotal (Total Children Is Unduplicated) 128 350.500000 22926.2000 65.4100
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 351.7400 351.7400
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 9.000000 450.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 33 219.500000 14883.7200 67.8074
OCCT-97530HM-OT SESSION BY OT ASST 1 4.000000 58.5200 14.6300
PHY-97110-PT SESSION BY LICENSED PT 38 294.500000 19676.3900 66.8129
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 95 673.250000 44704.5800 66.4012
Subtotal (Total Children Is Unduplicated) 155 1201.250000 80124.9500 66.7013
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Total 1551.750000 103051.1500 66.4096
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Number of Children (Unduplicated) With at Least One Service 264
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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 4 4.000000 185.7600 0.0000
P 534 918.750000 58382.3300 58958.3700
D 9 9.000000 642.9600 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
221 552.500000 38806.8500 0.0000
Other 41 67.500000 5033.2500 0.0000
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Total 809 1551.750000 103051.1500 58958.3700