CMS/EIP Fiscal Report Center: 09
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:OTHER
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-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 15 30.000000 2250.0000 75.0000
Subtotal (Total Children Is Unduplicated) 21 46.000000 3450.0000 75.0000
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 15.000000 750.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 8 13.500000 675.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 17 21.500000 537.5000 25.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 4 4.000000 200.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 3 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 50 207.000000 10350.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 100 443.000000 22150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 29.000000 2071.7600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 8 32.000000 2286.0800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 18 57.000000 4072.0800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 9 40.000000 2857.6000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 228.000000 16288.3200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 52 232.000000 16574.0800 71.4400
TRAV-TRAVS-Travel by mile 104 5158.000000 2248.7800 0.4360
Subtotal (Total Children Is Unduplicated) 323 6484.000000 81261.2000 12.5326
-----------------------------------------------------------------------------------------------------------------------
Total 6530.000000 84711.2000 12.9726
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 343
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 448 5213.500000 68936.2000 68936.2000
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
107 1316.500000 15775.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 555 6530.000000 84711.2000 68936.2000