CMS/EIP Fiscal Report Center: 51
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 356 969.500000 35862.2500 36.9905
Subtotal (Total Children Is Unduplicated) 356 969.500000 35862.2500 36.9905
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 46 46.000000 3450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 11.000000 825.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 54 54.500000 3024.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 7.000000 525.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 86 145.500000 9335.4000 64.1608
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 137 800.750000 39987.5000 49.9376
OCCT-97530-OT SESSION BY LICENSED OT 44 162.000000 11573.2800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 40 157.000000 8980.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 26 130.000000 9164.3200 70.4948
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 108 649.500000 45552.0000 70.1339
SPL-92508-GROUP SPL SESSION PER CHILD 5 18.000000 249.8400 13.8800
Subtotal (Total Children Is Unduplicated) 284 1917.250000 115507.3400 60.2464
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Total 3032.250000 160704.9900 52.9986
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Number of Children (Unduplicated) With at Least One Service 475
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Center 51
Flag Claims Units Chgs Paid
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R 3 3.000000 166.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 593 387.750000 15292.5000 0.0000
P 39 40.000000 2082.5000 2213.0000
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
1656 2601.500000 143163.4900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2291 3032.250000 160704.9900 2213.0000