CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
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 1547 3728.500000 137899.0000 36.9851
Subtotal (Total Children Is Unduplicated) 1547 3728.500000 137899.0000 36.9851
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 20.500000 1537.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 26.500000 1470.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 175 326.500000 24487.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 73 117.000000 8775.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 56 90.500000 6787.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 146 276.500000 15345.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 87 104.500000 7837.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 273 977.500000 67308.2000 68.8575
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 805 7358.250000 367887.5000 49.9966
OCCT-97530-OT SESSION BY LICENSED OT 39 205.500000 14680.9200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 0.500000 28.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 48 218.750000 15627.5000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 45 270.750000 19342.3800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 3 7.750000 107.5700 13.8800
Subtotal (Total Children Is Unduplicated) 867 8061.500000 417674.4700 51.8110
-----------------------------------------------------------------------------------------------------------------------
Total 12767.500000 622881.6700 48.7865
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1732
-----------------------------------------------------------------------------------------------------------------------
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 260 166.750000 6169.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5981 4512.750000 198000.7500 0.0000
P 1 0.500000 18.5000 0.0000
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
2531 8087.500000 418692.6700 10.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8773 12767.500000 622881.6700 10.0000