CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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 1703 4717.750000 174514.5000 36.9910
Subtotal (Total Children Is Unduplicated) 1703 4717.750000 174514.5000 36.9910
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 10.500000 787.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 11.000000 825.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 54 75.000000 5625.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 35 50.000000 3750.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 38.000000 2850.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 39.000000 2164.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 45 61.500000 4612.5000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 155 293.000000 21137.3500 72.1411
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 39 161.000000 8050.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 32.000000 2286.0800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 20 61.000000 4357.8400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 114.3200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 45.250000 3211.2200 70.9662
Subtotal (Total Children Is Unduplicated) 81 301.250000 18019.4600 59.8156
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Total 5312.000000 213671.3100 40.2243
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Number of Children (Unduplicated) With at Least One Service 1706
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Center 01
Flag Claims Units Chgs Paid
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R 44 20.750000 767.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 6794 4406.000000 163235.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 97 129.000000 9133.7100 0.0000
S 747 742.750000 39788.3500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
22 13.500000 746.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7704 5312.000000 213671.3100 0.0000