CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 1713 5179.250000 191632.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1713 5179.250000 191632.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 15.500000 1162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 25 60.000000 4500.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 13.500000 749.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 115 176.000000 13200.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 21.500000 1612.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 30.500000 2287.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 283 448.500000 24891.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 208 351.000000 26325.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 375 1124.500000 75136.9000 66.8181
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 153 539.500000 26912.5000 49.8842
OCCT-97530-OT SESSION BY LICENSED OT 27 133.000000 9501.5200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 2 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 39 215.000000 15359.6000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 5 14.000000 800.2400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 31 125.500000 8965.7200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 4 10.000000 138.8000 13.8800
Subtotal (Total Children Is Unduplicated) 229 1041.000000 61907.1800 59.4690
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Total 7344.750000 328676.3300 44.7498
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Number of Children (Unduplicated) With at Least One Service 1737
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Center 01
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 201 200.750000 14300.8000 0.0000
P 2 2.000000 100.0000 100.0000
D 93 94.500000 4788.1000 0.0000
S 2432 1816.500000 79687.3700 0.0000
H 6550 4741.250000 198682.6200 198557.6000
T 0 0.000000 0.0000 0.0000
13 6.750000 284.1900 0.0000
Other 300 483.000000 30833.2500 0.0000
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Total 9591 7344.750000 328676.3300 198657.6000