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
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 1109 3464.750000 128010.7500 36.9466
Subtotal (Total Children Is Unduplicated) 1109 3464.750000 128010.7500 36.9466
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 21.000000 1575.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 13.000000 975.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 17.500000 1312.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 93 147.000000 10987.5000 74.7449
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 44 64.000000 4800.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 20.000000 1500.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 28.000000 1554.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 63.500000 4762.5000 75.0000
SCREEN-T1023-SCREENING 8 8.000000 400.0000 50.0000
Subtotal (Total Children Is Unduplicated) 204 386.500000 28135.7500 72.7962
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 98 436.000000 21800.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 65 325.750000 23257.3400 71.3963
PHY-97110-PT SESSION BY LICENSED PT 60 275.500000 19681.7200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 4 4.000000 228.6400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 56 279.250000 19949.6200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 269 1321.500000 84931.2000 64.2688
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Total 5172.750000 241077.7000 46.6053
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Number of Children (Unduplicated) With at Least One Service 1122
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Center 54
Flag Claims Units Chgs Paid
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R 106 99.250000 4119.9700 0.0000
U 0 0.000000 0.0000 0.0000
B 2939 2487.000000 119424.4300 108.4400
P 2886 2377.250000 105120.5700 104483.5900
D 91 90.500000 6172.5400 0.0000
S 0 0.000000 0.0000 0.0000
H 38 37.000000 2621.8400 37.0000
T 0 0.000000 0.0000 0.0000
29 29.000000 1597.7200 0.0000
Other 71 52.750000 2020.6300 27.7500
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Total 6160 5172.750000 241077.7000 104656.7800