CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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 447 1280.500000 47276.7500 36.9205
Subtotal (Total Children Is Unduplicated) 447 1280.500000 47276.7500 36.9205
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 18.000000 1350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 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 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 57 111.500000 8362.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 38.000000 2850.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 18.000000 1350.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 50.000000 2747.2500 54.9450
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 13 13.000000 650.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 89 260.500000 18027.0500 69.2017
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 77 437.250000 21862.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 0.750000 37.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 12.000000 857.2800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 6.000000 428.6400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 112.000000 8001.2800 71.4400
Subtotal (Total Children Is Unduplicated) 102 568.000000 31187.2000 54.9070
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Total 2109.000000 96491.0000 45.7520
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Number of Children (Unduplicated) With at Least One Service 468
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Center 52
Flag Claims Units Chgs Paid
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R 5 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 315 287.250000 14058.4100 0.0000
P 1314 1295.250000 60248.6600 60075.1200
D 0 0.000000 0.0000 0.0000
S 469 452.750000 17240.7500 233.2500
H 35 42.000000 2818.6800 447.7600
T 0 0.000000 0.0000 0.0000
26 28.500000 2004.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2164 2109.000000 96491.0000 60756.1300