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
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 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
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 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 27 54.000000 4050.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 37 69.500000 3857.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 96 163.500000 12262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 38 65.500000 4912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 62 94.500000 7050.0000 74.6032
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 261 438.500000 24254.5000 55.3124
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 268 490.000000 36525.0000 74.5408
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) 575 1501.000000 102250.3000 68.1215
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 39 68.250000 1706.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 468 4576.500000 228775.0000 49.9891
OCCT-97530-OT SESSION BY LICENSED OT 29 171.000000 12145.0400 71.0236
OCCT-97530HM-OT SESSION BY OT ASST 3 6.000000 343.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 47 363.250000 25907.7400 71.3221
PHY-97110HM-PT SESSION BY PT ASST 2 4.000000 228.6400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 40 290.750000 20656.0600 71.0441
Subtotal (Total Children Is Unduplicated) 529 5479.750000 289761.9300 52.8787
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Total 14368.750000 664767.4800 46.2648
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Number of Children (Unduplicated) With at Least One Service 1704
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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
50 36.250000 1982.3700 0.0000
Other 5 6.250000 333.2500 0.0000
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Total 15301 14368.750000 664767.4800 470757.5200