CMS/EIP Fiscal Report Center: 54
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 1212 3877.500000 143264.0000 36.9475
Subtotal (Total Children Is Unduplicated) 1212 3877.500000 143264.0000 36.9475
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 19 32.000000 2400.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 24.000000 1800.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 21.000000 1575.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 126 193.500000 14475.0000 74.8062
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 67 91.500000 6862.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 28.000000 2100.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 41.000000 2275.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 83.000000 6225.0000 75.0000
SCREEN-T1023-SCREENING 8 8.000000 400.0000 50.0000
Subtotal (Total Children Is Unduplicated) 288 530.500000 38653.0000 72.8615
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 97 432.000000 21600.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 63 282.750000 20185.4200 71.3896
PHY-97110-PT SESSION BY LICENSED PT 58 236.500000 16895.5600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 3.000000 171.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 54 233.250000 16663.3800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 263 1188.500000 75529.7200 63.5505
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Total 5596.500000 257446.7200 46.0014
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Number of Children (Unduplicated) With at Least One Service 1232
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Center 54
Flag Claims Units Chgs Paid
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R 110 106.000000 4369.7200 0.0000
U 0 0.000000 0.0000 0.0000
B 3253 2814.750000 134643.6800 145.4400
P 3180 2675.750000 118433.3200 117735.5900
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 6543 5596.500000 257446.7200 117881.0300