CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 44.500000 3286.5000 73.8539
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 50 83.500000 4634.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 17.500000 1312.5000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 75 156.500000 9888.9000 63.1879
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 195.0000 195.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 313 2018.500000 100845.0000 49.9604
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 62 71.750000 3587.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 25 196.000000 13972.3700 71.2876
OCCT-97530GT-OT SESSION BY LICENSED OT 7 8.750000 625.1000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 19 120.500000 8505.1300 70.5820
PHY-97110GT-PT SESSION BY LICENSED PT 3 3.000000 213.1900 71.0633
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 74 433.500000 30967.4800 71.4359
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 10 12.000000 857.2800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 1 17.000000 7.3400 0.4318
Subtotal (Total Children Is Unduplicated) 403 2884.000000 159846.4300 55.4253
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Total 3040.500000 169735.3300 55.8248
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Number of Children (Unduplicated) With at Least One Service 436
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Center 01
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 2698 2729.250000 150294.1500 150294.1500
D 96 95.000000 5863.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 181 186.250000 11493.1800 11155.5400
0 0.000000 0.0000 0.0000
Other 18 30.000000 2084.2500 0.0000
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Total 2993 3040.500000 169735.3300 161449.6900