CMS/EIP Fiscal Report Center: 52
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 431 1506.500000 55694.2500 36.9693
Subtotal (Total Children Is Unduplicated) 431 1506.500000 55694.2500 36.9693
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 26.000000 1950.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 32 65.500000 4873.5000 74.4046
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 15 28.500000 1571.9000 55.1544
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
SCREEN-T1023-SCREENING 7 7.000000 350.0000 50.0000
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 68 185.000000 12720.4500 68.7592
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 36 102.000000 5100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 27 86.000000 4300.0000 50.0000
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 9 36.750000 2625.4200 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 16 65.500000 4679.3200 71.4400
Subtotal (Total Children Is Unduplicated) 60 291.250000 16776.1800 57.6006
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Total 1982.750000 85190.8800 42.9660
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Number of Children (Unduplicated) With at Least One Service 440
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Center 52
Flag Claims Units Chgs Paid
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R 3 6.000000 450.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1333 1360.500000 60598.7000 0.0000
P 270 242.000000 9200.1900 9255.6900
D 0 0.000000 0.0000 0.0000
S 321 352.000000 13702.7400 46.7500
H 0 0.000000 0.0000 0.0000
T 1 1.000000 37.0000 0.0000
20 21.250000 1202.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1948 1982.750000 85190.8800 9302.4400