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: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 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 28.000000 2100.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 15.000000 832.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 12.500000 937.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 18.000000 1350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 52.000000 2886.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 66 107.500000 8062.5000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 118 248.000000 17171.6400 69.2405
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 35 192.250000 9612.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 15.000000 750.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 42.250000 3018.3400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 4 4.750000 339.3400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 20 112.250000 8019.1400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 11 13.000000 928.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 32 165.000000 11787.6000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 16.250000 1160.9000 71.4400
Subtotal (Total Children Is Unduplicated) 88 562.750000 35716.5400 63.4679
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Total 810.750000 52888.1800 65.2336
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Number of Children (Unduplicated) With at Least One Service 192
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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 0 0.000000 0.0000 0.0000
D 1 1.500000 83.2500 0.0000
S 3 3.000000 171.4400 0.0000
H 461 509.250000 34380.4800 0.0000
T 0 0.000000 0.0000 0.0000
277 297.000000 18253.0100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 742 810.750000 52888.1800 0.0000