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
Agency Filter:EIP DEI DEIP
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
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 1 2.000000 150.0000 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 9 17.000000 943.5000 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 9 16.000000 1200.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 13.500000 1012.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 38 65.000000 3607.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 45 86.500000 6412.5000 74.1329
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 102 262.000000 17951.0000 68.5153
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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 12 22.000000 550.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 213 829.000000 41450.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 16 70.000000 4943.8400 70.6263
OCCT-97530HM-OT SESSION BY OT ASST 3 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 35 143.000000 10201.6400 71.3401
PHY-97110HM-PT SESSION BY PT ASST 9 15.000000 857.4000 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) 269 1212.750000 67117.3600 55.3431
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Total 3094.250000 144851.1100 46.8130
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Number of Children (Unduplicated) With at Least One Service 764
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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
406 370.750000 19324.4400 0.0000
Other 4 2.750000 170.6300 0.0000
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Total 3354 3094.250000 144851.1100 68772.7800