CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2019 ending 03/31/2019 Date of Report:05/04/2019 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 648 1630.500000 60310.0000 36.9887
Subtotal (Total Children Is Unduplicated) 648 1630.500000 60310.0000 36.9887
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 16.000000 1200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 20.500000 1137.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 29 44.000000 3225.0000 73.2955
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 15.500000 1162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 13.000000 975.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 85.000000 4717.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 71 124.000000 9225.0000 74.3952
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 138 331.000000 22592.7500 68.2560
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 17.000000 425.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 206 775.250000 38762.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 57.000000 4072.0800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 3 3.000000 171.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 23 78.500000 5593.7600 71.2581
PHY-97110HM-PT SESSION BY PT ASST 8 14.000000 800.2400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 64.750000 4568.1800 70.5510
Subtotal (Total Children Is Unduplicated) 242 1009.500000 54393.3600 53.8815
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Total 2971.000000 137296.1100 46.2121
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Number of Children (Unduplicated) With at Least One Service 773
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Center 53
Flag Claims Units Chgs Paid
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R 7 8.250000 381.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1344 1283.000000 59727.9900 118.5000
P 1809 1679.750000 77186.8700 75841.6300
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3160 2971.000000 137296.1100 75960.1300