CMS/EIP Fiscal Report Center: 52
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 483 1393.750000 51272.7500 36.7876
Subtotal (Total Children Is Unduplicated) 483 1393.750000 51272.7500 36.7876
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 10.500000 787.5000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 59 117.000000 8775.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 71.000000 5325.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 50.000000 2775.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
SCREEN-T1023-SCREENING 14 14.000000 700.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 92 293.500000 20459.6500 69.7092
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 78 400.000000 20000.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 18.250000 1303.7800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 6.000000 428.6400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 140.250000 10019.4600 71.4400
Subtotal (Total Children Is Unduplicated) 107 564.500000 31751.8800 56.2478
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Total 2251.750000 103484.2800 45.9573
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Number of Children (Unduplicated) With at Least One Service 501
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Center 52
Flag Claims Units Chgs Paid
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R 13 12.500000 547.0000 18.5000
U 0 0.000000 0.0000 0.0000
B 299 289.000000 14333.2300 0.0000
P 1701 1624.000000 73761.4500 73552.8500
D 0 0.000000 0.0000 0.0000
S 231 199.000000 7309.5000 0.0000
H 39 37.750000 2523.5800 74.9000
T 1 0.250000 9.2500 0.0000
102 89.000000 4991.0200 0.0000
Other 1 0.250000 9.2500 9.2500
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Total 2387 2251.750000 103484.2800 73655.5000