CMS/EIP Fiscal Report Center: 57
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:MED
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-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 29.000000 2175.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 29.000000 1609.5000 55.5000
OCTH-97167-OT EVAL HIGH COMPLEXITY 12 12.000000 612.6000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 24 72.000000 4499.2000 62.4889
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 831 6367.500000 318375.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 71 84.000000 4200.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 40.000000 2857.6000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 3.000000 171.6000 57.2000
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 11.000000 785.8400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 27.000000 1543.3200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 2.500000 178.6000 71.4400
Subtotal (Total Children Is Unduplicated) 836 6536.000000 328183.4000 50.2117
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Total 6608.000000 332682.6000 50.3454
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Number of Children (Unduplicated) With at Least One Service 845
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Center 57
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 1 2.000000 111.0000 111.0000
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
2187 6606.000000 332571.6000 332621.6000
Other 0 0.000000 0.0000 0.0000
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Total 2188 6608.000000 332682.6000 332732.6000