CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2019 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 1917 8366.250000 309135.0000 36.9502
Subtotal (Total Children Is Unduplicated) 1917 8366.250000 309135.0000 36.9502
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 19.000000 1425.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 13.000000 975.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 9.500000 712.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 18 32.000000 2362.5000 73.8281
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 34 54.000000 2997.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 75 131.000000 9750.0000 74.4275
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 28 48.500000 3637.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 79 134.000000 10050.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 25 44.500000 3337.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 67 107.000000 8025.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 23.500000 1762.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 262 431.500000 23865.0000 55.3071
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 79 136.500000 7520.2500 55.0934
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 268 479.000000 35887.5000 74.9217
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 98.000000 7350.0000 75.0000
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 682 1793.000000 121778.3500 67.9188
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 30 76.000000 1900.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 306 2494.710000 124709.8000 49.9897
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 132 656.250000 32812.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 43 238.750000 17056.3000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 24 69.000000 4929.3600 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 26 80.500000 5750.9200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 49 368.000000 26133.6800 71.0154
PHY-97110GT-PT SESSION BY LICENSED PT 14 41.000000 2929.0400 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 9 12.250000 875.1400 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 29 108.750000 7708.2600 70.8806
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 53 277.000000 19731.3200 71.2322
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 24 37.500000 2679.0000 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 7 11.000000 785.8400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 32 103.500000 7394.0400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 1.000000 13.8800 13.8800
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 2.500000 34.7000 13.8800
Subtotal (Total Children Is Unduplicated) 509 4579.710000 255586.6600 55.8085
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Total 14738.960000 686500.0100 46.5772
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Number of Children (Unduplicated) With at Least One Service 1949
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Center 53
Flag Claims Units Chgs Paid
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R 39 30.500000 1548.0900 0.0000
U 0 0.000000 0.0000 0.0000
B 3617 3156.750000 151650.4000 149.1900
P 12547 11551.710000 533301.5200 534595.8900
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 16203 14738.960000 686500.0100 534745.0800