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
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 1673 7388.000000 272755.2500 36.9187
Subtotal (Total Children Is Unduplicated) 1673 7388.000000 272755.2500 36.9187
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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 36 67.000000 5025.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 49 92.500000 6937.5000 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 30 60.000000 4500.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 75 147.500000 8186.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 98 166.000000 12450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 64 105.000000 7875.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 69 105.500000 7875.0000 74.6445
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 448 758.500000 41870.2500 55.2014
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 387 685.500000 51187.5000 74.6718
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) 673 2196.000000 146367.5900 66.6519
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 50 89.250000 2231.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 966 12099.25000 604823.5000 49.9885
OCCT-97530-OT SESSION BY LICENSED OT 60 414.500000 29505.0000 71.1821
OCCT-97530HM-OT SESSION BY OT ASST 8 11.000000 629.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 65 464.250000 33066.0600 71.2247
PHY-97110HM-PT SESSION BY PT ASST 5 9.000000 514.4400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 46 311.750000 22156.3000 71.0707
Subtotal (Total Children Is Unduplicated) 1025 13399.00000 692925.7500 51.7147
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Total 22983.000000 1112048.5900 48.3857
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Number of Children (Unduplicated) With at Least One Service 1742
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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 4400 3987.750000 182527.2200 218.8800
P 10574 10076.500000 466105.1500 465119.3700
D 84 81.000000 4885.2800 0.0000
S 155 147.500000 6806.2300 5419.2700
H 22 24.000000 1689.8000 0.0000
T 1 0.250000 9.2500 0.0000
8399 8650.500000 449263.4800 0.0000
Other 5 6.250000 333.2500 0.0000
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Total 23650 22983.000000 1112048.5900 470757.5200