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: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 3 9.750000 360.7500 37.0000
Subtotal (Total Children Is Unduplicated) 3 9.750000 360.7500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 22.000000 1650.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 37 76.500000 5567.5000 72.7778
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 13.000000 975.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 18 34.000000 1952.3500 57.4221
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 56 163.500000 11307.9500 69.1618
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 54.750000 2737.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 31.000000 1550.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 3.000000 214.3200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 5 18.500000 1321.6400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 54.250000 3875.6200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 26 147.250000 10210.9000 69.3440
Subtotal (Total Children Is Unduplicated) 50 308.750000 19909.9800 64.4858
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Total 482.000000 31578.6800 65.5159
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Number of Children (Unduplicated) With at Least One Service 99
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Center 52
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 17 27.500000 1695.5100 1509.6300
D 0 0.000000 0.0000 0.0000
S 4 4.000000 285.7600 0.0000
H 46 51.750000 3544.0200 0.0000
T 197 202.250000 13259.7000 8288.7500
163 196.500000 12793.6900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 427 482.000000 31578.6800 9798.3800