CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 2330 6849.750000 253440.7500 37.0000
Subtotal (Total Children Is Unduplicated) 2330 6849.750000 253440.7500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 16.500000 915.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 257 459.500000 34462.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 125 216.000000 16170.7500 74.8646
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 64 100.000000 7500.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 282 507.000000 28138.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 65.000000 4875.0000 75.0000
Subtotal (Total Children Is Unduplicated) 378 1384.000000 93562.5000 67.6030
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 7.500000 535.8000 71.4400
Subtotal (Total Children Is Unduplicated) 3 8.500000 585.8000 68.9176
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Total 8242.250000 347589.0500 42.1716
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Number of Children (Unduplicated) With at Least One Service 2331
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Center 10
Flag Claims Units Chgs Paid
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R 189 163.750000 6058.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3617 2974.500000 122701.0000 18.5000
P 6180 5104.000000 218829.3000 217635.9580
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 9986 8242.250000 347589.0500 217654.4580