CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 Page: 1
List order: No List
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 9 16.250000 601.2500 37.0000
Subtotal (Total Children Is Unduplicated) 9 16.250000 601.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 8 12.000000 804.2000 67.0167
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 52.000000 2600.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 33.500000 2393.2400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 7 26.000000 1857.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 210.000000 15002.4000 71.4400
Subtotal (Total Children Is Unduplicated) 62 321.500000 21853.0800 67.9723
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Total 349.750000 23258.5300 66.5004
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Number of Children (Unduplicated) With at Least One Service 74
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Center 07
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 122 331.500000 22507.2800 22507.2800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
26 16.250000 601.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 149 349.750000 23258.5300 22507.2800