CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 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 1 0.250000 9.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.500000 18.5000 37.0000
Subtotal (Total Children Is Unduplicated) 2 0.750000 27.7500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 6.000000 450.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 14.000000 1050.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 30 51.500000 2858.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 65.500000 4912.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 60 162.000000 10740.1500 66.2972
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 72.7600 72.7600
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 109 498.750000 24937.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 216 1331.000000 66550.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 91.500000 6536.7600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 26 170.250000 12162.6600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 7 25.000000 1786.0000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 24 257.750000 18110.8900 70.2653
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 26 85.250000 6090.2600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 87 566.000000 40365.0400 71.3163
Subtotal (Total Children Is Unduplicated) 348 3026.500000 176611.8700 58.3552
-----------------------------------------------------------------------------------------------------------------------
Total 3189.250000 187379.7700 58.7536
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 379
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 1467 1425.500000 80323.9400 80323.9400
D 36 35.750000 2045.8300 0.0000
S 2 2.000000 142.8800 0.0000
H 549 559.250000 35448.7200 0.0000
T 890 874.750000 51183.0700 50713.4500
275 292.000000 18235.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3219 3189.250000 187379.7700 131037.3900