CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2015 ending 06/30/2016 Date of Report:08/06/2016 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 8.500000 712.5000 83.8235
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 35 67.000000 3718.5000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 115 211.500000 12043.5000 56.9433
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 133 219.000000 17212.5000 78.5959
Subtotal (Total Children Is Unduplicated) 265 527.000000 35262.0000 66.9108
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 562 8493.750000 424575.0000 49.9868
Subtotal (Total Children Is Unduplicated) 562 8495.750000 424625.0000 49.9809
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Total 9022.750000 459887.0000 50.9697
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Number of Children (Unduplicated) With at Least One Service 669
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Center 53
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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
8811 8997.750000 458637.0000 400.0000
Other 0 0.000000 0.0000 0.0000
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Total 8811 8997.750000 458637.0000 400.0000