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:EIP DEI DEIP
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 46 77.000000 5024.8500 65.2578
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 13 21.000000 1575.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 51 93.000000 5101.5000 54.8548
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 29.000000 1980.0800 68.2786
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) 122 273.500000 17294.2800 63.2332
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 11 70.000000 5000.8000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 26 185.250000 12028.2800 64.9300
Subtotal (Total Children Is Unduplicated) 37 255.250000 17029.0800 66.7153
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Total 528.750000 34323.3600 64.9142
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Number of Children (Unduplicated) With at Least One Service 152
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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 359 453.250000 29593.3900 30169.4300
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
50 62.500000 3901.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 422 528.750000 34323.3600 30169.4300