CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2016 ending 06/30/2016 Date of Report:08/06/2016 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 731 2285.500000 84175.0000 36.8300
Subtotal (Total Children Is Unduplicated) 731 2285.500000 84175.0000 36.8300
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 30.000000 2250.0000 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 16 28.000000 1554.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.000000 1125.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 23.500000 1762.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 77 125.500000 6965.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 71 125.000000 9375.0000 75.0000
Subtotal (Total Children Is Unduplicated) 151 383.000000 25731.7500 67.1847
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 12 25.000000 1833.0000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 14 38.000000 950.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 258 1370.000000 68500.0000 50.0000
Subtotal (Total Children Is Unduplicated) 267 1433.000000 71283.0000 49.7439
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Total 4101.500000 181189.7500 44.1765
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Number of Children (Unduplicated) With at Least One Service 772
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Center 53
Flag Claims Units Chgs Paid
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R 157 140.500000 5158.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1471 1459.000000 69302.5000 0.0000
P 2001 1758.750000 73880.5000 73843.5000
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
834 741.250000 32748.0000 0.0000
Other 2 2.000000 100.0000 0.0000
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Total 4465 4101.500000 181189.7500 73843.5000