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: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
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 10.500000 787.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 25.000000 1387.5000 55.5000
Subtotal (Total Children Is Unduplicated) 20 35.500000 2175.0000 61.2676
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 1026.7600 513.3800
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 6.000000 300.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 55 335.500000 16775.6600 50.0020
OCCT-97530GT-OT SESSION BY LICENSED OT 3 26.000000 1857.4400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 2 16.000000 1143.0400 71.4400
Subtotal (Total Children Is Unduplicated) 62 385.500000 21102.9000 54.7416
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Total 421.000000 23277.9000 55.2919
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Number of Children (Unduplicated) With at Least One Service 75
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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 140 139.170000 8350.3900 8350.3900
278 281.830000 14927.5100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 418 421.000000 23277.9000 8350.3900