CMS/EIP Fiscal Report Center: 54
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:MED
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-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.000000 50.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 16.500000 915.7500 55.5000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.500000 138.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 76 133.000000 7381.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
Subtotal (Total Children Is Unduplicated) 97 168.500000 9619.2500 57.0875
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 85 191.000000 9550.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 346 2177.750000 108887.5000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 4 10.250000 732.2600 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 6.000000 428.6400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 3.000000 214.3200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 6 28.000000 2000.3200 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 6.000000 428.6400 71.4400
Subtotal (Total Children Is Unduplicated) 376 2422.000000 122241.6800 50.4714
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Total 2590.500000 131860.9300 50.9017
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Number of Children (Unduplicated) With at Least One Service 441
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Center 54
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 0 0.000000 0.0000 0.0000
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
2548 2590.500000 131860.9300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2548 2590.500000 131860.9300 0.0000