CMS/EIP Fiscal Report              Center: 06 
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:OTHER    
    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
  EXIT-EXIT-EXIT ASSESSMENT                                8              17.500000          875.0000           50.0000
  IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT       2               4.000000          300.0000           75.0000
  IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS       1               2.000000          111.0000           55.5000
Subtotal (Total Children Is Unduplicated)                 10              23.500000         1286.0000           54.7234
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EI Services,Class #03
  EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF            7              51.000000         2550.0000           50.0000
  EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF          1               2.000000          100.0000           50.0000
  PHY-97110-PT SESSION BY LICENSED PT                      1               5.500000          392.9200           71.4400
  SPL-92507-SPL THERAPY SESSION BY LICENSED SLP            2              15.000000         1071.6000           71.4400
Subtotal (Total Children Is Unduplicated)                  9              73.500000         4114.5200           55.9799
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Total                                                                     97.000000         5400.5200           55.6755
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Number of Children (Unduplicated) With at Least One Service         19
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Center 06
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              0       0.000000       0.0000       0.0000 
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 
              90      97.000000    5400.5200       0.0000 
Other          0       0.000000       0.0000       0.0000 
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Total         90      97.000000    5400.5200       0.0000