CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2018 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 1857 8255.750000 304963.7500 36.9396
Subtotal (Total Children Is Unduplicated) 1857 8255.750000 304963.7500 36.9396
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 40 72.500000 5437.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 27 52.000000 3900.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 32 63.000000 4725.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 40 75.500000 4190.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 126 207.500000 15487.5000 74.6386
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 51 85.500000 6412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 74 113.000000 8437.5000 74.6681
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 360 585.000000 32329.7500 55.2645
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 347 613.000000 45750.0000 74.6330
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) 731 1872.500000 127033.5500 67.8417
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 39 66.250000 1656.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 467 4564.500000 228175.0000 49.9890
OCCT-97530-OT SESSION BY LICENSED OT 28 146.000000 10359.0400 70.9523
OCCT-97530HM-OT SESSION BY OT ASST 2 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 41 327.250000 23335.9000 71.3091
PHY-97110HM-PT SESSION BY PT ASST 2 4.000000 228.6400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 239.750000 17012.6200 70.9598
Subtotal (Total Children Is Unduplicated) 523 5351.750000 280996.2500 52.5055
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Total 15480.000000 712993.5500 46.0590
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Number of Children (Unduplicated) With at Least One Service 1901
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Center 53
Flag Claims Units Chgs Paid
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R 10 9.250000 428.9300 0.0000
U 0 0.000000 0.0000 0.0000
B 4768 4375.250000 199760.4700 246.6300
P 11489 11095.500000 512804.1500 511836.4200
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 16267 15480.000000 712993.5500 512083.0500