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: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
TCM-T1017TL-TARGETED CASE MANAGEMENT 4 10.250000 379.2500 37.0000
Subtotal (Total Children Is Unduplicated) 4 10.250000 379.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 52 114.000000 8079.8400 70.8758
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 26.000000 1794.6800 69.0262
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 20.000000 1435.0000 71.7500
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 48.000000 2664.0000 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 7 7.000000 350.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 71 233.500000 15567.3200 66.6695
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 38 207.000000 10315.0000 49.8309
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 0.750000 37.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 9.000000 642.9600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 36 176.250000 12591.3000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 142.8800 71.4400
Subtotal (Total Children Is Unduplicated) 69 395.000000 23729.6400 60.0750
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Total 638.750000 39676.2100 62.1154
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Number of Children (Unduplicated) With at Least One Service 131
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Center 52
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 2 2.000000 100.0000 0.0000
P 31 41.000000 2889.5000 2095.5000
D 4 4.000000 200.0000 200.0000
S 4 6.000000 311.0000 122.5000
H 110 146.500000 9739.4800 0.0000
T 326 345.500000 21092.6000 14625.7700
85 93.750000 5343.6300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 562 638.750000 39676.2100 17043.7700