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
Payclass Filters:TPIN
Eligibility Filter:Program Patients
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 6 10.000000 750.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 13 32.000000 2400.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 18.000000 999.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 45 74.000000 5499.0000 74.3108
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 4 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 99 159.500000 8852.2500 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 85 142.500000 10687.5000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 357.3500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 168 469.500000 31467.5400 67.0235
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 195.0000 195.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 346 2210.750000 110457.5000 49.9638
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 74 86.750000 4337.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 34 238.250000 16990.7100 71.3146
OCCT-97530GT-OT SESSION BY LICENSED OT 11 13.500000 964.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 39 232.750000 16524.2700 70.9958
PHY-97110GT-PT SESSION BY LICENSED PT 14 16.000000 1141.9100 71.3694
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 106 598.500000 42755.0800 71.4371
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 24 28.250000 2018.1800 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) 468 3446.750000 195562.9700 56.7384
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Total 3916.250000 227030.5100 57.9714
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Number of Children (Unduplicated) With at Least One Service 547
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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 2713 2753.250000 151869.9000 151869.9000
D 98 97.500000 6002.5000 0.0000
S 3 3.000000 171.4400 0.0000
H 477 533.750000 36022.9800 0.0000
T 181 186.250000 11493.1800 11155.5400
283 306.000000 18928.0100 0.0000
Other 22 36.500000 2542.5000 0.0000
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Total 3777 3916.250000 227030.5100 163025.4400