CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 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
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 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-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 10 19.000000 1325.0000 69.7368
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 16 31.500000 2317.5000 73.5714
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 51 100.000000 4949.5400 49.4954
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 68 166.500000 9579.2400 57.5330
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EI Services,Class #03
OCCT-97530GT-OT SESSION BY LICENSED OT 2 15.000000 1071.6000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 6 40.500000 2893.3200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 8.750000 625.1000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 19.000000 1241.3200 65.3326
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 5 27.000000 1928.8800 71.4400
Subtotal (Total Children Is Unduplicated) 18 110.250000 7760.2200 70.3875
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Total 276.750000 17339.4600 62.6539
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Number of Children (Unduplicated) With at Least One Service 83
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Center 09
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 115 150.250000 9183.2700 9595.1300
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 36 58.000000 3603.1600 3171.1600
47 68.500000 4553.0300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 198 276.750000 17339.4600 12766.2900