CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2019 ending 06/30/2019 Date of Report:07/21/2019 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 834 2070.500000 76497.5000 36.9464
Subtotal (Total Children Is Unduplicated) 834 2070.500000 76497.5000 36.9464
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 11.500000 862.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 50.500000 3787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 32.000000 2400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 46.000000 3412.5000 74.1848
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 101 160.000000 8797.7500 54.9859
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 79 142.500000 10612.5000 74.4737
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 198 473.000000 31887.0500 67.4145
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 16 19.250000 481.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 185 832.750000 41637.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 23 90.000000 6415.3600 71.2818
OCCT-97530HM-OT SESSION BY OT ASST 2 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 32 200.250000 14291.5800 71.3687
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 139.500000 9908.3200 71.0274
Subtotal (Total Children Is Unduplicated) 263 1284.750000 72905.5700 56.7469
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Total 3828.250000 181290.1200 47.3559
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Number of Children (Unduplicated) With at Least One Service 916
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Center 53
Flag Claims Units Chgs Paid
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R 9 8.250000 378.9300 0.0000
U 0 0.000000 0.0000 0.0000
B 2922 2691.750000 127086.0900 18.5000
P 1188 1128.250000 53825.1000 53800.1000
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 4119 3828.250000 181290.1200 53818.6000