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
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
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 14.000000 777.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 16.000000 1200.0000 75.0000
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) 30 52.000000 3292.7500 63.3221
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1205.9200 1205.9200
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 175 1161.000000 58050.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 82 352.000000 17600.0000 50.0000
INTR-T1013-INTERPRETER 2 3.500000 175.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 43.000000 2396.9200 55.7423
OCCT-97530GT-OT SESSION BY LICENSED OT 1 13.000000 928.7200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 17 81.000000 5500.6700 67.9095
PHY-97110GT-PT SESSION BY LICENSED PT 3 20.000000 1428.8000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 170.250000 11697.3600 68.7070
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 26 158.250000 11305.3800 71.4400
Subtotal (Total Children Is Unduplicated) 286 2003.000000 110288.7700 55.0618
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Total 2055.000000 113581.5200 55.2708
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Number of Children (Unduplicated) With at Least One Service 302
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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 0 0.000000 0.0000 0.0000
T 603 600.500000 33547.1700 32280.8400
0 0.000000 0.0000 0.0000
Other 3 6.000000 411.0000 0.0000
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Total 2063 2055.000000 113581.5200 106271.6300