CMS/EIP Fiscal Report Center: 06
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 1216 3101.750000 114746.7500 36.9942
Subtotal (Total Children Is Unduplicated) 1216 3101.750000 114746.7500 36.9942
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 184 291.000000 21825.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 33 51.500000 3862.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 62 96.500000 7237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 172 275.500000 15290.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
Subtotal (Total Children Is Unduplicated) 231 728.500000 49236.0000 67.5855
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 730 5112.000000 255600.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 121 151.750000 7587.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 25 99.000000 7072.5600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 3 2.000000 142.8800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 11 50.000000 2860.0000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.500000 85.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 39 145.000000 10287.3600 70.9473
PHY-97110GT-PT SESSION BY LICENSED PT 1 0.500000 35.7200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 7 14.500000 828.8200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 121.500000 8679.9600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 3.500000 250.0400 71.4400
Subtotal (Total Children Is Unduplicated) 807 5701.250000 293430.6400 51.4678
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Total 9531.500000 457413.3900 47.9897
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Number of Children (Unduplicated) With at Least One Service 1330
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Center 06
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 0 0.000000 0.0000 0.0000
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
11313 9531.500000 457413.3900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11313 9531.500000 457413.3900 0.0000