CMS/EIP Fiscal Report Center: 51
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 2 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 7 8.000000 460.7500 57.5938
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.000000 200.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 43 176.750000 11949.3400 67.6059
OCCT-97530HM-OT SESSION BY OT ASST 26 109.000000 6234.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 22 81.250000 5786.6400 71.2202
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 78 294.250000 20878.3400 70.9544
Subtotal (Total Children Is Unduplicated) 118 665.250000 45049.1200 67.7176
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Total 673.250000 45509.8700 67.5973
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Number of Children (Unduplicated) With at Least One Service 121
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Center 51
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 199 635.250000 43010.9300 43010.9300
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
18 38.000000 2498.9400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 217 673.250000 45509.8700 43010.9300