CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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 1809 5837.500000 215987.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1809 5837.500000 215987.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 19.000000 1425.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 0.500000 37.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 16 35.000000 2625.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 29.000000 1609.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 63 106.500000 7987.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 14.500000 1087.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.500000 487.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 163 255.000000 14152.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 139 229.500000 17212.5000 75.0000
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 233 701.500000 46928.6900 66.8976
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 132 496.500000 24825.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 23 25.250000 1262.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 28 154.500000 11037.4800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 11 10.500000 739.4400 70.4229
PHY-97110-PT SESSION BY LICENSED PT 36 181.000000 12930.6400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 6 9.000000 642.9600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 36 151.250000 10805.3000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 6.500000 464.3600 71.4400
Subtotal (Total Children Is Unduplicated) 214 1035.500000 62764.8400 60.6131
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Total 7574.500000 325681.0300 42.9970
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Number of Children (Unduplicated) With at Least One Service 1821
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Center 01
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2 1.750000 64.7500 64.7500
D 161 164.750000 9032.7000 0.0000
S 2 1.500000 89.9400 0.0000
H 10571 7123.000000 298282.8900 297861.9900
T 0 0.000000 0.0000 0.0000
1 1.500000 112.5000 0.0000
Other 173 282.000000 18098.2500 0.0000
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Total 10910 7574.500000 325681.0300 297926.7400