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: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
EVAL-96111-DEVELOPMENTAL EVALUATION 2 3.000000 150.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 10 12.000000 600.0000 50.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 29 54.493067 4086.9800 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 2.881489 147.1000 51.0500
Subtotal (Total Children Is Unduplicated) 46 74.374556 5134.0800 69.0301
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 18.000000 1285.9200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 12.000000 857.2800 71.4400
Subtotal (Total Children Is Unduplicated) 6 30.000000 2143.2000 71.4400
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Total 104.374556 7277.2800 69.7227
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Number of Children (Unduplicated) With at Least One Service 50
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Center 55
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 42 64.000000 4437.9400 0.0000
T 0 0.000000 0.0000 0.0000
44 40.374556 2839.3400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 86 104.374556 7277.2800 0.0000