CMS/EIP Fiscal Report Center: 03
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
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 52.3700 26.1850
Subtotal (Total Children Is Unduplicated) 3 3.000000 103.4200 34.4733
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 8.000000 400.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 6.750000 281.4300 41.6933
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 3.500000 100.0400 28.5829
Subtotal (Total Children Is Unduplicated) 10 20.250000 902.9100 44.5881
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Total 23.250000 1006.3300 43.2830
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Number of Children (Unduplicated) With at Least One Service 11
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Center 03
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 2 2.000000 17.0400 17.0400
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
22 21.250000 989.2900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 24 23.250000 1006.3300 17.0400