CMS/EIP Fiscal Report Center: 54
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-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 23.500000 1304.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.500000 138.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 22 32.500000 1901.2500 58.5000
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1086.9400 1086.9400
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 71 566.500000 18425.0000 32.5243
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 9 11.000000 550.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 18.000000 1285.9200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 2 8.000000 571.5200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 40.250000 2875.4600 71.4400
Subtotal (Total Children Is Unduplicated) 89 645.750000 24866.2800 38.5076
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Total 678.250000 26767.5300 39.4656
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Number of Children (Unduplicated) With at Least One Service 107
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Center 54
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 1 1.000000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 267 269.880000 15329.8700 15329.8700
211 407.370000 11382.1600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 479 678.250000 26767.5300 15329.8700