CMS/EIP Fiscal Report Center: 55
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 1 0.250000 9.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1 0.250000 9.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 29 49.715999 3728.7000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 0.133333 10.0000 75.0002
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 11.378800 853.4100 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 39 64.228132 4745.2600 73.8813
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EI Services,Class #03
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 285.7600 71.4400
Subtotal (Total Children Is Unduplicated) 4 5.000000 310.7600 62.1520
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Total 69.478132 5065.2700 72.9045
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Number of Children (Unduplicated) With at Least One Service 40
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Center 55
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 8 14.000000 1042.8800 0.0000
T 0 0.000000 0.0000 0.0000
36 54.478132 3971.3400 0.0000
Other 1 1.000000 51.0500 0.0000
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Total 45 69.478132 5065.2700 0.0000