CMS/EIP Fiscal Report Center: 57
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
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 3 3.000000 153.1500 51.0500
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 36 102.000000 5100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 463 2465.000000 123250.0000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 4 19.000000 1357.3600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 13.000000 928.7200 71.4400
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 0.750000 42.8700 57.1600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.500000 35.7200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 142.8800 71.4400
Subtotal (Total Children Is Unduplicated) 483 2602.250000 130857.5500 50.2863
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Total 2605.250000 131010.7000 50.2872
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Number of Children (Unduplicated) With at Least One Service 484
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Center 57
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
861 2605.250000 131010.7000 131010.7000
Other 0 0.000000 0.0000 0.0000
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Total 861 2605.250000 131010.7000 131010.7000