CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 Page: 1
List order: No List
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 1077 4071.500000 150617.7500 36.9932
Subtotal (Total Children Is Unduplicated) 1077 4071.500000 150617.7500 36.9932
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 11.500000 862.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 68 130.000000 9750.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 33 64.500000 4837.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 53 101.000000 7575.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 91 175.000000 9662.5000 55.2143
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 10.500000 787.5000 75.0000
Subtotal (Total Children Is Unduplicated) 136 519.000000 35238.2500 67.8964
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 311 1794.000000 89700.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 354 2178.000000 108900.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 31 153.000000 10930.3200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 19 99.000000 7072.5600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 41 179.000000 12787.7600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 21 135.000000 9644.4000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 87 432.000000 30862.0800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 47 304.250000 21735.6200 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 5.000000 357.2000 71.4400
Subtotal (Total Children Is Unduplicated) 659 5279.250000 291989.9400 55.3090
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Total 9869.750000 477845.9400 48.4152
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Number of Children (Unduplicated) With at Least One Service 1154
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Center 09
Flag Claims Units Chgs Paid
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R 39 50.500000 2146.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 593 638.000000 24876.2500 0.0000
P 3737 3761.500000 147262.0000 147262.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3 13.000000 481.0000 425.5000
1586 5198.250000 287939.9400 0.0000
Other 107 208.500000 15140.2500 0.0000
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Total 6065 9869.750000 477845.9400 147687.5000