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: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 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
OCTH-97167-OT EVAL HIGH COMPLEXITY 8 8.000000 408.4000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 13.000000 663.6500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 30 54.000000 3163.2000 58.5778
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 425 3209.000000 160450.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 45 57.000000 2850.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 49.500000 3536.2800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 5.000000 286.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 15 53.000000 3786.3200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 27.000000 1543.3200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 152.000000 10858.8800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
Subtotal (Total Children Is Unduplicated) 436 3553.500000 183382.2400 51.6061
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Total 3607.500000 186545.4400 51.7104
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Number of Children (Unduplicated) With at Least One Service 443
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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 186 94.000000 6674.5800 6674.5800
D 0 0.000000 0.0000 0.0000
S 26 16.500000 1093.0000 1093.0000
H 0 0.000000 0.0000 0.0000
T 1039 3027.000000 151847.4600 151847.4600
229 470.000000 26930.4000 26930.4000
Other 0 0.000000 0.0000 0.0000
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Total 1480 3607.500000 186545.4400 186545.4400