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: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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 37.500000 2807.8100 74.8749
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 37.500000 2081.2500 55.5000
Subtotal (Total Children Is Unduplicated) 21 75.000000 4889.0600 65.1875
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EI Services,Class #03
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 46.000000 2300.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 2.000000 100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 60 184.500000 12351.8300 66.9476
OCCT-97530GT-OT SESSION BY LICENSED OT 7 5.500000 392.9200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 14 39.000000 2187.8400 56.0985
OCCT-97530HMGT-OT SESSION BY OT ASST 4 2.500000 114.4000 45.7600
PHY-97110-PT SESSION BY LICENSED PT 52 218.000000 14702.1500 67.4411
PHY-97110GT-PT SESSION BY LICENSED PT 7 4.500000 321.4800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 2 2.000000 114.3200 57.1600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 135 562.000000 39096.8000 69.5673
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 38 34.750000 2472.5400 71.1522
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.500000 107.1600 71.4400
Subtotal (Total Children Is Unduplicated) 239 1106.250000 74983.4400 67.7816
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Total 1181.250000 79872.5000 67.6169
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Number of Children (Unduplicated) With at Least One Service 258
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Center 06
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 1407 807.250000 55069.5100 55069.5100
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
591 374.000000 24802.9900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1998 1181.250000 79872.5000 55069.5100