CMS/EIP Fiscal Report Center: 03
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
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1 1.000000 51.0500 51.0500
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 2.750000 137.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 25.000000 1457.1800 58.2872
PHY-97110-PT SESSION BY LICENSED PT 6 16.500000 1178.7600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 21.750000 1334.6800 61.3646
Subtotal (Total Children Is Unduplicated) 15 66.000000 4108.1200 62.2442
-----------------------------------------------------------------------------------------------------------------------
Total 67.000000 4159.1700 62.0772
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 15
-----------------------------------------------------------------------------------------------------------------------
Center 03
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 18 17.500000 1116.6400 1116.6400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 4.000000 285.7600 285.7600
T 0 0.000000 0.0000 0.0000
46 45.500000 2756.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 68 67.000000 4159.1700 1402.4000