CMS/EIP Fiscal Report Center: 55
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 779 2594.750000 96005.7500 37.0000
Subtotal (Total Children Is Unduplicated) 779 2594.750000 96005.7500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 90 178.670133 13400.2600 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 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 32 64.000000 3552.0000 55.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 99 257.670133 17918.5100 69.5405
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 0.750000 37.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 18 103.000000 5150.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 10.750000 767.9800 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 12 75.250000 5375.8600 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 17.750000 1268.0600 71.4400
Subtotal (Total Children Is Unduplicated) 32 207.500000 12599.4000 60.7200
-----------------------------------------------------------------------------------------------------------------------
Total 3059.920133 126523.6600 41.3487
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 779
-----------------------------------------------------------------------------------------------------------------------
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2270 1790.083333 77216.8400 92.5000
P 2078 1263.250000 49031.3100 49883.4100
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
12 5.750000 212.7500 0.0000
Other 1 0.836800 62.7600 0.0000
---------------------------------------------------------
Total 4361 3059.920133 126523.6600 49975.9100