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
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 795 1885.000000 69541.5000 36.8920
Subtotal (Total Children Is Unduplicated) 795 1885.000000 69541.5000 36.8920
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.7100 19.7100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 27.8300 27.8300
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.500000 637.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 22.500000 1248.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 43.000000 3225.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 28.500000 2137.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 33.000000 2437.5000 73.8636
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 113 188.500000 10346.2500 54.8873
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 95 164.000000 12225.0000 74.5427
SCREEN-T1023-SCREENING 1 2.000000 100.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 172 516.000000 34181.0900 66.2424
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 16 22.250000 556.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 461 2457.500000 122875.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 44 176.500000 12573.4800 71.2378
OCCT-97530HM-OT SESSION BY OT ASST 7 7.000000 400.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 53 289.250000 20649.7400 71.3906
PHY-97110HM-PT SESSION BY PT ASST 3 3.000000 171.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 35 172.500000 12265.8400 71.1063
Subtotal (Total Children Is Unduplicated) 566 3128.000000 169492.1900 54.1855
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Total 5529.000000 273214.7800 49.4149
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Number of Children (Unduplicated) With at Least One Service 951
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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 2708 2457.500000 116154.8400 18.5000
P 1083 1002.000000 47890.3500 47865.3500
D 35 32.000000 1958.9000 0.0000
S 40 40.000000 1697.4600 1411.7000
H 14 16.000000 1118.2800 0.0000
T 1 0.250000 9.2500 0.0000
1931 1970.750000 103923.5200 0.0000
Other 2 2.250000 83.2500 0.0000
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Total 5823 5529.000000 273214.7800 49295.5500