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
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 5 7.500000 562.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 9.000000 675.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 35 59.000000 4311.1700 73.0707
Subtotal (Total Children Is Unduplicated) 42 77.000000 5631.9200 73.1418
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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 22 149.500000 9882.9200 66.1065
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 70 488.000000 32676.3000 66.9596
Subtotal (Total Children Is Unduplicated) 120 946.000000 63095.8700 66.6975
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Total 1023.000000 68727.7900 67.1826
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Number of Children (Unduplicated) With at Least One Service 160
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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 175 465.500000 28788.9400 28788.9400
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
171 490.000000 34905.6000 0.0000
Other 41 67.500000 5033.2500 0.0000
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Total 387 1023.000000 68727.7900 28788.9400