CMS/EIP Fiscal Report Center: 51
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/20/2020 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 275 640.750000 23707.7500 37.0000
Subtotal (Total Children Is Unduplicated) 275 640.750000 23707.7500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 8.500000 608.2500 71.5588
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 40 41.500000 2303.2500 55.5000
Subtotal (Total Children Is Unduplicated) 42 52.000000 3022.5000 58.1250
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 5.500000 275.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 2.750000 196.4600 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 6 9.000000 642.9600 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 8 18.750000 1339.5000 71.4400
Subtotal (Total Children Is Unduplicated) 15 37.000000 2503.9200 67.6735
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Total 729.750000 29234.1700 40.0605
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Number of Children (Unduplicated) With at Least One Service 294
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Center 51
Flag Claims Units Chgs Paid
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R 15 8.000000 296.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 932 719.250000 28839.1700 0.0000
P 3 2.500000 99.0000 74.0000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 950 729.750000 29234.1700 74.0000