CMS/EIP Fiscal Report Center: 52
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-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 39 82.000000 5700.0000 69.5122
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 16 32.000000 1776.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 7 7.000000 350.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 10.000000 479.8400 47.9840
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 75 157.000000 10160.0400 64.7136
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 53 273.250000 13562.5000 49.6340
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 24 72.750000 3637.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 27 98.500000 6626.0600 67.2696
OCCT-97530GT-OT SESSION BY LICENSED OT 9 19.750000 1268.0600 64.2056
OCCT-97530HM-OT SESSION BY OT ASST 10 29.500000 1401.4000 47.5051
OCCT-97530HMGT-OT SESSION BY OT ASST 2 2.500000 143.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 34 197.000000 12537.7200 63.6432
PHY-97110GT-PT SESSION BY LICENSED PT 2 7.500000 321.4800 42.8640
PHY-97110TL-PT SESSION BY LICENSED PT 1 3.750000 267.9000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 103 714.500000 47185.8500 66.0404
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 34.250000 2339.6600 68.3112
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 71.4400
Subtotal (Total Children Is Unduplicated) 206 1455.250000 89434.0100 61.4561
-----------------------------------------------------------------------------------------------------------------------
Total 1612.250000 99594.0500 61.7733
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 240
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 441 935.250000 58422.3500 58422.3500
344 677.000000 41171.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 785 1612.250000 99594.0500 58422.3500