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: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 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
Subtotal (Total Children Is Unduplicated) 13 24.000000 1702.5000 70.9375
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 8 45.250000 2429.8400 53.6981
OCCT-97530GT-OT SESSION BY LICENSED OT 3 27.000000 1678.8300 62.1789
PHY-97110-PT SESSION BY LICENSED PT 21 146.000000 10304.4600 70.5785
PHY-97110GT-PT SESSION BY LICENSED PT 18 94.000000 6715.3600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 50 326.000000 21516.6500 66.0020
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 28 169.000000 9728.5200 57.5652
Subtotal (Total Children Is Unduplicated) 95 807.250000 52373.6600 64.8791
-----------------------------------------------------------------------------------------------------------------------
Total 831.250000 54076.1600 65.0540
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 107
-----------------------------------------------------------------------------------------------------------------------
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 86 214.250000 12485.3400 12485.3400
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
193 595.000000 40038.3200 0.0000
Other 12 22.000000 1552.5000 0.0000
---------------------------------------------------------
Total 291 831.250000 54076.1600 12485.3400