CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2015 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 1430 7672.750000 282097.2500 36.7661
Subtotal (Total Children Is Unduplicated) 1430 7672.750000 282097.2500 36.7661
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 43 86.000000 6450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 56 110.500000 8287.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 18 34.000000 2550.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 80 144.000000 7936.5000 55.1146
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 78 137.500000 10312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 81.500000 6112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 17.000000 1275.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 317 517.500000 28665.7500 55.3928
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 347 616.000000 46162.5000 74.9391
Subtotal (Total Children Is Unduplicated) 644 1745.000000 117827.2500 67.5228
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 24 57.000000 1425.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 370 3985.250000 199212.5000 49.9875
Subtotal (Total Children Is Unduplicated) 379 4042.250000 200637.5000 49.6351
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Total 13460.000000 600562.0000 44.6183
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Number of Children (Unduplicated) With at Least One Service 1465
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Center 53
Flag Claims Units Chgs Paid
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R 356 291.000000 10718.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3799 3752.250000 169335.7500 3172.7500
P 10041 9416.750000 420508.2500 420425.0000
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 14196 13460.000000 600562.0000 423597.7500