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
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 2233 6504.500000 240666.5000 37.0000
Subtotal (Total Children Is Unduplicated) 2233 6504.500000 240666.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 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 7 12.500000 693.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 224 403.500000 30262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 111 190.500000 14258.2500 74.8465
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 92.000000 6900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 249 448.500000 24891.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 54.500000 4087.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 6.000000 306.3000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 3 3.000000 153.1500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 349 1241.000000 83527.2400 67.3064
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 31.000000 3014.4600 97.2406
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1207 11625.50000 581275.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 169 701.000000 50002.2400 71.3299
OCCT-97530HM-OT SESSION BY OT ASST 13 42.250000 2416.7000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 209 836.500000 59725.2400 71.3990
PHY-97110HM-PT SESSION BY PT ASST 9 11.000000 628.7600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 195 1049.500000 74839.3900 71.3096
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 3 5.000000 69.4000 13.8800
Subtotal (Total Children Is Unduplicated) 1434 14303.75000 772085.5900 53.9778
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Total 22049.250000 1096279.3300 49.7196
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Number of Children (Unduplicated) With at Least One Service 2432
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Center 10
Flag Claims Units Chgs Paid
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R 180 151.000000 5587.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3445 2783.250000 114456.2500 18.5000
P 5905 4781.750000 203023.3000 201829.9580
D 6 6.250000 231.2500 0.0000
S 34 86.000000 4300.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4575 14240.500000 768663.0300 0.0000
Other 1 0.500000 18.5000 0.0000
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Total 14146 22049.250000 1096279.3300 201848.4580