CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 8.000000 444.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.000000 600.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 28 39.500000 2488.6500 63.0038
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 72.7600 72.7600
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 109 498.750000 24937.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 177 1023.000000 51150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 91.500000 6536.7600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 15 102.750000 7340.4600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 7 25.000000 1786.0000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 12 138.000000 9555.9500 69.2460
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 26 85.250000 6090.2600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 56 334.250000 23808.8200 71.2306
Subtotal (Total Children Is Unduplicated) 287 2299.500000 131278.5100 57.0900
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Total 2339.000000 133767.1600 57.1899
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Number of Children (Unduplicated) With at Least One Service 303
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Center 01
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 1467 1425.500000 80323.9400 80323.9400
D 36 35.750000 2045.8300 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 890 874.750000 51183.0700 50713.4500
3 3.000000 214.3200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2396 2339.000000 133767.1600 131037.3900