CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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 1215 4195.000000 155215.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1215 4195.000000 155215.0000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 11.500000 862.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.500000 637.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 18.500000 1026.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 93 146.000000 10950.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 73.000000 5475.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 75 127.000000 9477.5000 74.6260
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 132 229.000000 12681.7500 55.3788
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 66 103.500000 7762.5000 75.0000
Subtotal (Total Children Is Unduplicated) 220 738.500000 50486.0000 68.3629
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 832 5650.250000 282512.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 52 296.000000 21132.0000 71.3919
PHY-97110-PT SESSION BY LICENSED PT 98 731.000000 52222.6400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 161 1249.500000 89264.2800 71.4400
Subtotal (Total Children Is Unduplicated) 993 7926.750000 445131.4200 56.1556
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Total 12860.250000 650832.4200 50.6081
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Number of Children (Unduplicated) With at Least One Service 1394
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Center 09
Flag Claims Units Chgs Paid
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R 2 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 332 357.000000 14796.2500 0.0000
P 4181 4460.250000 178881.2500 182507.2500
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 3 6.000000 333.0000 450.0000
2488 7769.500000 437469.6700 0.0000
Other 156 266.000000 19296.7500 0.0000
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Total 7162 12860.250000 650832.4200 182957.2500