CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2021 ending 03/31/2021 Date of Report:05/04/2021 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 924 2478.000000 91630.5000 36.9776
Subtotal (Total Children Is Unduplicated) 924 2478.000000 91630.5000 36.9776
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 16.000000 1200.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 15.000000 1125.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 73 140.500000 10537.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 17.500000 1312.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 54 104.500000 7837.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 35 64.000000 4800.0000 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 129 239.000000 13264.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 57 106.000000 7950.0000 75.0000
Subtotal (Total Children Is Unduplicated) 209 744.500000 50845.5000 68.2948
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 12.500000 625.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 173 817.000000 40850.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 5.000000 357.2000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 11 49.000000 3500.5600 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 27 109.000000 7786.9600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 0.750000 53.5800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 21 115.750000 8269.1800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 5.000000 357.2000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 19.500000 1393.0800 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 30 161.000000 11480.4000 71.3068
Subtotal (Total Children Is Unduplicated) 258 1295.500000 74744.6000 57.6956
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Total 4518.000000 217220.6000 48.0789
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Number of Children (Unduplicated) With at Least One Service 978
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Center 53
Flag Claims Units Chgs Paid
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R 25 22.000000 951.7600 0.0000
U 0 0.000000 0.0000 0.0000
B 2773 2543.000000 123295.2400 0.0000
P 2196 1953.000000 92973.6000 92973.6000
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 4994 4518.000000 217220.6000 92973.6000