CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2016 ending 06/30/2016 Date of Report:08/07/2016 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 673 2073.000000 76414.2500 36.8617
Subtotal (Total Children Is Unduplicated) 673 2073.000000 76414.2500 36.8617
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 29.500000 2212.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 29.500000 1637.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 28.500000 2137.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 95 152.500000 8463.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 99 171.500000 12862.5000 75.0000
Subtotal (Total Children Is Unduplicated) 180 437.000000 29226.0000 66.8787
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 34.000000 850.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 215 1108.250000 55412.5000 50.0000
Subtotal (Total Children Is Unduplicated) 220 1142.250000 56262.5000 49.2559
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Total 3652.250000 161902.7500 44.3296
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Number of Children (Unduplicated) With at Least One Service 741
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Center 53
Flag Claims Units Chgs Paid
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R 164 148.500000 5454.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1577 1577.250000 75902.5000 0.0000
P 2167 1926.500000 80545.5000 80508.5000
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 3908 3652.250000 161902.7500 80508.5000