CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 Page: 1
List order: No List
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 19.500000 1462.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 11.000000 825.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 15.500000 860.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 25 44.000000 2442.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 29 59.500000 4462.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 69 198.500000 13466.5500 67.8416
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1205.9200 1205.9200
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 191 1218.500000 60925.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 109 444.500000 22225.0000 50.0000
INTR-T1013-INTERPRETER 2 3.500000 175.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 63.500000 3861.4400 60.8101
OCCT-97530GT-OT SESSION BY LICENSED OT 13 47.000000 3357.6800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 26 106.000000 7286.6700 68.7422
PHY-97110GT-PT SESSION BY LICENSED PT 12 49.500000 3536.2800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 40 209.750000 14519.2400 69.2216
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 46 212.250000 15163.1400 71.4400
Subtotal (Total Children Is Unduplicated) 347 2356.500000 132305.3700 56.1449
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Total 2555.000000 145771.9200 57.0536
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Number of Children (Unduplicated) With at Least One Service 381
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Center 01
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 1352 1344.000000 73990.7900 73990.7900
D 105 104.500000 5632.5600 0.0000
S 0 0.000000 0.0000 0.0000
H 320 352.000000 22407.9300 0.0000
T 603 600.500000 33547.1700 32280.8400
134 148.000000 9782.4700 0.0000
Other 3 6.000000 411.0000 0.0000
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Total 2517 2555.000000 145771.9200 106271.6300