CMS/EIP Fiscal Report Center: 52
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
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 33 68.000000 4950.0000 72.7941
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 22.000000 1350.0000 61.3636
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 84.000000 4440.0000 52.8571
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 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
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 11 12.000000 550.0000 45.8333
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 85 228.500000 13980.0500 61.1818
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 84 416.500000 20725.0000 49.7599
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 17 17.250000 862.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 29 107.250000 7090.4200 66.1111
OCCT-97530HM-OT SESSION BY OT ASST 12 65.500000 3746.6000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 2 3.000000 171.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 29 154.500000 9519.3800 61.6141
PHY-97110GT-PT SESSION BY LICENSED PT 8 8.250000 517.9400 62.7806
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 80 497.250000 34380.5000 69.1413
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 11.500000 821.5600 71.4400
Subtotal (Total Children Is Unduplicated) 193 1283.000000 77871.5000 60.6949
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Total 1511.500000 91851.5500 60.7685
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Number of Children (Unduplicated) With at Least One Service 230
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Center 52
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 584 1096.750000 68151.4300 68151.4300
249 412.750000 23550.1200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 834 1511.500000 91851.5500 68151.4300