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
Payclass Filters:TPIN
Eligibility Filter:Program Patients
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 4 7.000000 525.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 54 86.000000 6182.5000 71.8895
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 36.000000 2600.0000 72.2222
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 30 48.000000 3575.2000 74.4833
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 51 88.000000 4784.0000 54.3636
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 47 78.500000 5519.5000 70.3121
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 132 370.500000 24943.5000 67.3239
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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 28 187.000000 12192.7600 65.2019
OCCT-97530GT-OT SESSION BY LICENSED OT 3 3.000000 214.3200 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 88 581.500000 39549.4300 68.0128
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 13.000000 928.7200 71.4400
Subtotal (Total Children Is Unduplicated) 138 1064.500000 72407.8500 68.0205
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Total 1435.000000 97351.3500 67.8407
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Number of Children (Unduplicated) With at Least One Service 257
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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 505 906.000000 60079.1400 60201.0000
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
192 460.000000 32147.8200 0.0000
Other 38 60.000000 4470.7500 0.0000
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Total 743 1435.000000 97351.3500 60201.0000