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
Payclass Filters:TPIN
Eligibility Filter:Program Patients
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 2 4.000000 300.0000 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 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 33 56.500000 4097.5000 72.5221
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 13 23.500000 1663.9700 70.8072
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 14 25.000000 1825.0000 73.0000
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 69 128.500000 6746.5200 52.5021
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.500000 637.5000 75.0000
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) 107 264.000000 16263.9900 61.6060
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 9 46.250000 2501.2800 54.0817
OCCT-97530GT-OT SESSION BY LICENSED OT 5 32.000000 2036.0300 63.6259
OCCT-97530TLGT-OT SESSION BY LICENSED OT 8 27.000000 1928.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 21 146.000000 10304.4600 70.5785
PHY-97110GT-PT SESSION BY LICENSED PT 19 95.000000 6786.8000 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 34 193.000000 11443.0800 59.2906
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 22.000000 1571.6800 71.4400
Subtotal (Total Children Is Unduplicated) 113 887.250000 58088.8600 65.4707
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Total 1151.250000 74352.8500 64.5845
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Number of Children (Unduplicated) With at Least One Service 199
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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 229 418.250000 25367.2700 26157.7800
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
265 707.500000 47170.5800 0.0000
Other 14 25.500000 1815.0000 0.0000
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Total 508 1151.250000 74352.8500 26157.7800