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
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 661 1619.500000 59782.7500 36.9143
Subtotal (Total Children Is Unduplicated) 661 1619.500000 59782.7500 36.9143
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 13.8700 13.8700
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 27.8300 27.8300
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.500000 937.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 28.000000 1554.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 34.500000 2587.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 35.000000 2625.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 24.500000 1837.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 76 132.000000 7326.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 66 121.500000 9037.5000 74.3827
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 133 416.500000 27909.2000 67.0089
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 15.000000 1099.8000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 23.000000 575.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 465 2118.750000 105848.5000 49.9580
OCCT-97530-OT SESSION BY LICENSED OT 39 160.500000 11281.0000 70.2866
OCCT-97530HM-OT SESSION BY OT ASST 4 5.000000 286.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 44 167.000000 11859.0800 71.0125
PHY-97110HM-PT SESSION BY PT ASST 11 21.000000 1200.3600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 25 111.750000 7744.2400 69.2997
SPL-92508-GROUP SPL SESSION PER CHILD 1 3.000000 41.6400 13.8800
Subtotal (Total Children Is Unduplicated) 528 2625.000000 139935.6200 53.3088
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Total 4661.000000 227627.5700 48.8366
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Number of Children (Unduplicated) With at Least One Service 870
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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 1234 1166.000000 54255.2400 118.5000
P 1628 1486.000000 68238.1200 67091.0300
D 18 13.000000 718.5200 0.0000
S 55 46.000000 1655.7500 1563.2500
H 2 1.500000 107.1600 0.0000
T 0 0.000000 0.0000 0.0000
1915 1937.500000 102100.9000 0.0000
Other 4 2.750000 170.6300 0.0000
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Total 4863 4661.000000 227627.5700 68772.7800