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: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 1302 7206.750000 264883.0000 36.7548
Subtotal (Total Children Is Unduplicated) 1302 7206.750000 264883.0000 36.7548
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 53 106.000000 7950.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 56 110.500000 8287.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 16 30.000000 2250.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 74 135.000000 7492.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 64 117.000000 8775.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 65.500000 4912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 11.000000 825.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 236 389.000000 21589.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 254 460.000000 34462.5000 74.9185
Subtotal (Total Children Is Unduplicated) 491 1424.000000 96544.5000 67.7981
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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 24 61.000000 1525.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 392 4268.000000 213350.0000 49.9883
Subtotal (Total Children Is Unduplicated) 406 4354.000000 216708.0000 49.7722
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Total 12984.750000 578135.5000 44.5242
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Number of Children (Unduplicated) With at Least One Service 1312
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Center 53
Flag Claims Units Chgs Paid
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R 315 256.500000 9441.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 3523 3439.750000 154073.5000 3172.7500
P 9179 8481.500000 378706.7500 378623.5000
D 0 0.000000 0.0000 0.0000
S 2 2.750000 101.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
899 802.250000 35712.0000 0.0000
Other 2 2.000000 100.0000 0.0000
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Total 13920 12984.750000 578135.5000 381796.2500