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
Agency Filter:EIP DEI DEIP
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-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 6 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 51 51.500000 2858.2500 55.5000
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
Subtotal (Total Children Is Unduplicated) 62 66.500000 3780.2500 56.8459
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 26.000000 1300.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 79.000000 4795.4800 60.7023
Subtotal (Total Children Is Unduplicated) 18 105.000000 6095.4800 58.0522
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Total 1141.000000 45737.9800 40.0859
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Number of Children (Unduplicated) With at Least One Service 378
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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 38 38.000000 2062.5000 2193.0000
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
1041 712.250000 28216.4800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1675 1141.000000 45737.9800 2193.0000