CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 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 973 3252.000000 120314.7500 36.9972
Subtotal (Total Children Is Unduplicated) 973 3252.000000 120314.7500 36.9972
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 30.000000 2250.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 11.500000 862.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 18.500000 1026.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 124 180.000000 13395.0000 74.4167
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 60 79.500000 5937.5000 74.6855
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 43 72.000000 5356.4400 74.3950
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 149 238.500000 13236.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 61 76.000000 5637.5000 74.1776
Subtotal (Total Children Is Unduplicated) 237 713.500000 48264.9400 67.6453
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 39 197.000000 9850.0000 50.0000
Subtotal (Total Children Is Unduplicated) 39 197.000000 9850.0000 50.0000
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Total 4162.500000 178429.6900 42.8660
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Number of Children (Unduplicated) With at Least One Service 980
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Center 09
Flag Claims Units Chgs Paid
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R 1 2.750000 101.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 92 100.750000 5069.0000 58.5000
P 4182 4057.000000 173147.9400 173147.9400
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
1 2.000000 111.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4276 4162.500000 178429.6900 173206.4400