CMS/EIP Fiscal Report Center: 07
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 5 10.000000 750.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 714.7000 51.0500
Subtotal (Total Children Is Unduplicated) 22 28.000000 1668.9000 59.6036
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 33 160.000000 8000.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.750000 87.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 17 82.500000 5893.8000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 142.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 10 46.000000 3286.2400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 101 662.250000 47261.1400 71.3645
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 10.750000 767.9800 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
Subtotal (Total Children Is Unduplicated) 141 967.250000 65553.9400 67.7735
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Total 995.250000 67222.8400 67.5437
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Number of Children (Unduplicated) With at Least One Service 151
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Center 07
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 428 990.500000 66903.8900 66903.8900
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
3 4.750000 318.9500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 431 995.250000 67222.8400 66903.8900