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:EIP DEI DEIP
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
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 24 41.000000 2985.0000 72.8049
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 16.500000 1187.5000 71.9697
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 15.500000 1112.5000 71.7742
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 43 81.000000 4147.7700 51.2070
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162GT-PT EVAL MODERATE 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 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 72 172.000000 10465.2700 60.8446
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 5.000000 357.2000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 8 27.000000 1928.8800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 24.000000 1714.5600 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 22.000000 1571.6800 71.4400
Subtotal (Total Children Is Unduplicated) 18 80.000000 5715.2000 71.4400
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Total 252.000000 16180.4700 64.2082
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Number of Children (Unduplicated) With at Least One Service 81
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Center 09
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 115 153.500000 9893.4600 10121.3600
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
64 98.500000 6287.0100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 179 252.000000 16180.4700 10121.3600