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
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 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
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 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 7 12.500000 693.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 40.500000 3037.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 21.500000 1612.5000 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 67 111.000000 6078.2500 54.7590
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 64 118.500000 8812.5000 74.3671
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) 152 365.500000 24735.5500 67.6759
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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 187 835.750000 41787.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 24 101.000000 7201.2000 71.2990
OCCT-97530HM-OT SESSION BY OT ASST 2 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 37 215.250000 15363.1800 71.3737
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 164.500000 11694.3200 71.0901
Subtotal (Total Children Is Unduplicated) 273 1338.750000 76699.0100 57.2915
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Total 3589.250000 170976.0600 47.6356
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Number of Children (Unduplicated) With at Least One Service 867
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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
42 31.000000 1684.8000 0.0000
Other 2 2.250000 83.2500 0.0000
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Total 3934 3589.250000 170976.0600 49295.5500