CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2 0.500000 18.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6 7.750000 277.5000 35.8065
Subtotal (Total Children Is Unduplicated) 6 8.250000 296.0000 35.8788
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 52.667000 3950.0250 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 38.420400 2881.5300 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 16 16.000000 816.8000 51.0500
Subtotal (Total Children Is Unduplicated) 55 113.087400 7952.5550 70.3222
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 1.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 33 160.000000 8000.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.750000 87.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 17 82.500000 5893.8000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 142.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 10 46.000000 3286.2400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 101 662.250000 47261.1400 71.3645
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 10.750000 767.9800 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
Subtotal (Total Children Is Unduplicated) 142 968.500000 65553.9400 67.6861
-----------------------------------------------------------------------------------------------------------------------
Total 1089.837400 73802.4950 67.7188
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 184
-----------------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 0.500000 18.5000 0.0000
P 434 995.587400 67285.4450 67285.4200
D 16 31.000000 2301.0500 0.0000
S 3 2.250000 96.2500 0.0000
H 18 35.000000 2601.0500 0.0000
T 0 0.000000 0.0000 0.0000
22 25.500000 1500.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 495 1089.837400 73802.4950 67285.4200