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
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 661 2138.000000 78588.0000 36.7577
Subtotal (Total Children Is Unduplicated) 661 2138.000000 78588.0000 36.7577
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Screening, Eval, and Assessment,Class #02
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.8400 21.8400
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 34.000000 2550.0000 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 9 16.500000 1237.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 36 68.000000 3774.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 27.500000 2062.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 21.000000 1575.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 105 183.500000 10184.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 121 218.000000 16312.5000 74.8280
Subtotal (Total Children Is Unduplicated) 189 623.500000 41767.5900 66.9889
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 17.000000 425.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 459 2434.500000 121675.0000 49.9795
Subtotal (Total Children Is Unduplicated) 461 2451.500000 122100.0000 49.8062
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Total 5213.000000 242455.5900 46.5098
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Number of Children (Unduplicated) With at Least One Service 736
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Center 53
Flag Claims Units Chgs Paid
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R 127 93.000000 3587.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2041 1856.750000 80312.5000 0.0000
P 1885 1797.500000 83583.0000 83527.5000
D 0 0.000000 0.0000 0.0000
S 5 8.750000 551.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1412 1457.000000 74420.5900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5470 5213.000000 242455.5900 83527.5000