CMS/EIP Fiscal Report Center: 52
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 3 0.750000 27.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 18 22.000000 804.7500 36.5795
Subtotal (Total Children Is Unduplicated) 20 22.750000 832.5000 36.5934
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 36 87.000000 5838.1700 67.1054
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 58.000000 3774.4800 65.0772
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 13.500000 849.4900 62.9252
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 51.500000 2858.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
SCREEN-T1023-SCREENING 7 7.000000 350.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 54 224.000000 14084.5400 62.8774
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 49 298.500000 14925.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 28.000000 2000.3200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 27 143.750000 9859.9000 68.5906
Subtotal (Total Children Is Unduplicated) 77 470.250000 26785.2200 56.9595
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Total 717.000000 41702.2600 58.1621
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Number of Children (Unduplicated) With at Least One Service 132
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Center 52
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 72 93.250000 6318.4300 3474.7500
D 0 0.000000 0.0000 0.0000
S 16 13.250000 481.0000 0.0000
H 63 78.750000 5314.2300 0.0000
T 327 333.250000 18576.5200 12768.8700
180 198.500000 11012.0800 145.0000
Other 0 0.000000 0.0000 0.0000
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Total 658 717.000000 41702.2600 16388.6200