CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2019 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 1822 7992.750000 295315.5000 36.9479
Subtotal (Total Children Is Unduplicated) 1822 7992.750000 295315.5000 36.9479
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 14.000000 1050.0000 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 6 9.500000 712.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.500000 487.5000 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 17 30.500000 2287.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 43.000000 2386.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 64 115.500000 8587.5000 74.3506
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 29 53.500000 4012.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 68 117.000000 8775.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 24 44.500000 3337.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 94.000000 7050.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 17 30.500000 2287.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 201 343.500000 18981.0000 55.2576
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 71 125.000000 6882.0000 55.0560
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 217 394.500000 29550.0000 74.9049
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 86.000000 6450.0000 75.0000
SCREEN-T1023-SCREENING 3 4.000000 200.0000 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) 563 1538.500000 104819.1000 68.1307
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 30 77.000000 1925.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 304 2511.460000 125547.3000 49.9898
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 141 806.500000 40325.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 53 395.750000 28258.1400 71.4040
OCCT-97530GT-OT SESSION BY LICENSED OT 26 74.000000 5286.5600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 29 102.250000 7304.7400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 53 590.750000 42046.9400 71.1755
PHY-97110GT-PT SESSION BY LICENSED PT 15 42.000000 3000.4800 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 9 16.250000 1160.9000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 31 155.500000 11048.0800 71.0487
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 57 419.500000 29911.5200 71.3028
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 25 40.500000 2893.3200 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 7 18.000000 1285.9200 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 35 128.000000 9144.3200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 3 2.000000 27.7600 13.8800
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 2.500000 34.7000 13.8800
Subtotal (Total Children Is Unduplicated) 522 5384.960000 309400.7600 57.4565
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Total 14916.210000 709535.3600 47.5681
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Number of Children (Unduplicated) With at Least One Service 1849
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Center 53
Flag Claims Units Chgs Paid
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R 31 21.500000 1187.3400 0.0000
U 0 0.000000 0.0000 0.0000
B 3396 2917.250000 140618.4000 149.1900
P 11607 10556.460000 487885.0200 487499.8900
D 615 548.000000 32850.6100 0.0000
S 0 0.000000 0.0000 0.0000
H 43 42.500000 2827.1600 50.0000
T 0 0.000000 0.0000 0.0000
716 629.500000 30299.2700 0.0000
Other 207 201.000000 13867.5600 0.0000
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Total 16615 14916.210000 709535.3600 487699.0800