CMS/EIP Fiscal Report Center: 53
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 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
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 14.000000 777.0000 55.5000
Subtotal (Total Children Is Unduplicated) 10 17.500000 1039.5000 59.4000
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 482.2300 241.1150
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 36.000000 1800.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 37 132.500000 6625.0000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 43 172.500000 9057.2300 52.5057
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Total 190.000000 10096.7300 53.1407
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Number of Children (Unduplicated) With at Least One Service 52
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Center 53
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 33 34.000000 1735.2500 1735.2500
149 156.000000 8361.4800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 182 190.000000 10096.7300 1735.2500