CMS/EIP Fiscal Report Center: 55
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
EVAL-96111-DEVELOPMENTAL EVALUATION 3 6.000000 300.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 15.857600 1189.3200 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 51.685866 3876.4400 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 20.468133 1535.1100 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
OCTH-97167-OT EVAL HIGH COMPLEXITY 5 4.979432 254.2000 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 8 12.000000 612.6000 51.0500
Subtotal (Total Children Is Unduplicated) 54 113.991031 7929.7200 69.5644
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 24 26.000000 1300.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 10 6.000000 150.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 5.000000 250.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 6.000000 150.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 23 23.000000 1150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 10 6.500000 162.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 40 147.600000 7380.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 37 185.683375 13265.2200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 43 229.793528 13144.1900 57.2000
PHY-97110-PT SESSION BY LICENSED PT 21 134.484582 9607.5785 71.4400
PHY-97110HM-PT SESSION BY PT ASST 16 103.305455 5904.9400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 91 544.810891 38878.4100 71.3613
Subtotal (Total Children Is Unduplicated) 227 1418.177831 91342.8385 64.4086
-----------------------------------------------------------------------------------------------------------------------
Total 1532.168862 99272.5585 64.7922
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 257
-----------------------------------------------------------------------------------------------------------------------
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 553 549.000000 36647.5100 36647.5100
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
1106 983.168862 62625.0485 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1659 1532.168862 99272.5585 36647.5100