CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 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 544 1409.250000 51938.7500 36.8556
Subtotal (Total Children Is Unduplicated) 544 1409.250000 51938.7500 36.8556
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 64 127.500000 9562.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 59 118.000000 8850.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 54.000000 4050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 149 282.500000 15678.7500 55.5000
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
Subtotal (Total Children Is Unduplicated) 168 598.000000 39035.2500 65.2763
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 123 574.500000 28725.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 58.4900 58.4900
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 13.500000 594.0100 44.0007
Subtotal (Total Children Is Unduplicated) 128 589.000000 29377.5000 49.8769
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Total 2596.250000 120351.5000 46.3559
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Number of Children (Unduplicated) With at Least One Service 571
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Center 52
Flag Claims Units Chgs Paid
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R 28 52.500000 3918.5000 1050.0000
U 0 0.000000 0.0000 0.0000
B 1826 1802.500000 89044.2500 15060.0000
P 890 741.250000 27388.7500 27386.2500
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 2744 2596.250000 120351.5000 43496.2500