CMS/EIP Fiscal Report Center: 06
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: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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.500000 862.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
Subtotal (Total Children Is Unduplicated) 12 47.000000 3066.7500 65.2500
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 492 3043.000000 152150.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 181 804.000000 40155.0000 49.9440
OCCT-97530-OT SESSION BY LICENSED OT 21 90.000000 6429.6000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 3 8.000000 392.9200 49.1150
OCCT-97530HM-OT SESSION BY OT ASST 6 18.000000 1029.6000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 2 8.000000 457.6000 57.2000
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 0.500000 35.7200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 32 94.000000 6715.3600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 10 26.000000 1814.5600 69.7908
PHY-97110HM-PT SESSION BY PT ASST 9 27.000000 1543.3200 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 2 1.500000 85.7400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 124.500000 8842.8400 71.0268
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 33.750000 2411.1000 71.4400
Subtotal (Total Children Is Unduplicated) 652 4278.250000 222063.3600 51.9052
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Total 4325.250000 225130.1100 52.0502
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Number of Children (Unduplicated) With at Least One Service 658
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Center 06
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
4628 4325.250000 225130.1100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4628 4325.250000 225130.1100 0.0000