CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 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 724 2395.750000 88115.5000 36.7799
Subtotal (Total Children Is Unduplicated) 724 2395.750000 88115.5000 36.7799
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 26.000000 1950.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 26 51.000000 3825.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 15.000000 1125.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 55.500000 3024.7500 54.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 35.500000 2662.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 26.500000 1987.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 117 195.500000 10850.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 112 199.000000 14887.5000 74.8116
Subtotal (Total Children Is Unduplicated) 235 608.500000 40650.0000 66.8036
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 15.000000 375.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 219 1165.000000 58200.0000 49.9571
Subtotal (Total Children Is Unduplicated) 226 1180.000000 58575.0000 49.6398
-----------------------------------------------------------------------------------------------------------------------
Total 4184.250000 187340.5000 44.7728
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 756
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 152 114.250000 4374.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2240 2067.250000 89376.7500 111.0000
P 2054 2002.750000 93589.7500 93534.2500
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
---------------------------------------------------------
Total 4446 4184.250000 187340.5000 93645.2500