CMS/EIP Fiscal Report Center: 52
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
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 42 92.000000 4662.0000 50.6739
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 3.000000 102.1000 34.0333
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 7 8.000000 350.0000 43.7500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 62 134.000000 7193.4500 53.6825
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 80 429.500000 20725.0000 48.2538
OCCT-97530-OT SESSION BY LICENSED OT 27 96.750000 6583.4900 68.0464
OCCT-97530HM-OT SESSION BY OT ASST 11 55.000000 3146.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 22 147.750000 9267.1600 62.7219
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 70 424.000000 27945.8700 65.9101
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
Subtotal (Total Children Is Unduplicated) 179 1157.000000 67723.0400 58.5333
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Total 1291.000000 74916.4900 58.0298
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Number of Children (Unduplicated) With at Least One Service 201
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Center 52
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 0 0.000000 0.0000 0.0000
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 333 662.250000 38869.6500 38823.9200
347 628.750000 36046.8400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 680 1291.000000 74916.4900 38823.9200