CMS/EIP Fiscal Report Center: 09
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 16 27.500000 1995.0000 72.5455
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 24.000000 1775.2000 73.9667
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 23.500000 1444.5000 61.4681
Subtotal (Total Children Is Unduplicated) 30 75.000000 5214.7000 69.5293
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 130.500000 8156.4000 62.5011
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 36 260.000000 18136.7000 69.7565
PHY-97110GT-PT SESSION BY LICENSED PT 5 18.000000 1285.9200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 72 480.500000 32558.9900 67.7606
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 5.000000 357.2000 71.4400
Subtotal (Total Children Is Unduplicated) 114 897.000000 60666.6500 67.6328
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Total 972.000000 65881.3500 67.7792
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Number of Children (Unduplicated) With at Least One Service 137
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Center 09
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 201 500.500000 32785.7500 32785.7500
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
170 433.500000 30245.6000 0.0000
Other 23 38.000000 2850.0000 0.0000
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Total 394 972.000000 65881.3500 32785.7500