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:EIP DEI DEIP
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 37.500000 2662.5000 71.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 29.500000 2112.5000 71.6102
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 31 54.500000 2924.7500 53.6651
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 33.500000 2462.5000 73.5075
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 79 180.500000 11943.5500 66.1693
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 10 56.500000 4036.3600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 101.000000 6990.4400 69.2123
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 8.000000 571.5200 71.4400
Subtotal (Total Children Is Unduplicated) 26 167.500000 11741.2000 70.0967
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Total 348.000000 23684.7500 68.0596
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Number of Children (Unduplicated) With at Least One Service 105
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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 2 3.000000 225.0000 0.0000
P 252 323.500000 21914.8900 21982.6500
D 6 6.000000 428.6400 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
15 15.500000 1116.2200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 275 348.000000 23684.7500 21982.6500