CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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 840 2229.000000 82241.7500 36.8963
Subtotal (Total Children Is Unduplicated) 840 2229.000000 82241.7500 36.8963
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.500000 750.0000 71.4286
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 24.500000 1359.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 50.500000 3787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 20.500000 1537.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 33.000000 2475.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 92 149.000000 8241.7500 55.3138
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 103 189.000000 14137.5000 74.8016
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 214 488.500000 33126.5000 67.8127
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 14.500000 362.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 198 991.110000 49555.3600 49.9999
OCCT-97530-OT SESSION BY LICENSED OT 22 96.000000 6858.2400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 34 182.750000 13041.3800 71.3619
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 25 86.000000 6143.8400 71.4400
Subtotal (Total Children Is Unduplicated) 272 1370.360000 75961.3200 55.4317
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Total 4087.860000 191329.5700 46.8043
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Number of Children (Unduplicated) With at Least One Service 921
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Center 53
Flag Claims Units Chgs Paid
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R 10 9.500000 454.8200 0.0000
U 0 0.000000 0.0000 0.0000
B 2524 2375.360000 112943.7300 336.5000
P 1794 1703.000000 77931.0200 77691.8200
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 4328 4087.860000 191329.5700 78028.3200