CMS/EIP Fiscal Report Center: 55
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:OTHER
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-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 7 13.000000 873.0500 67.1577
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 4.000000 200.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 6.500000 325.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 11.250000 803.7000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 7.500000 535.8000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 3 13.750000 982.3000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 4 10.000000 714.4000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 4.750000 271.5100 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 62.250000 4447.1400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 16.500000 1178.7600 71.4400
Subtotal (Total Children Is Unduplicated) 24 138.500000 9573.0100 69.1192
-----------------------------------------------------------------------------------------------------------------------
Total 151.500000 10446.0600 68.9509
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 27
-----------------------------------------------------------------------------------------------------------------------
Center 55
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 68 60.250000 4290.9900 4290.9900
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
94 91.250000 6155.0700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 162 151.500000 10446.0600 4290.9900