CMS/EIP Fiscal Report Center: 52
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 514 1247.000000 46037.2500 36.9184
Subtotal (Total Children Is Unduplicated) 514 1247.000000 46037.2500 36.9184
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 18.000000 999.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 50 100.000000 7500.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 84.000000 6300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 18.000000 1350.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 83 164.500000 9046.5000 54.9939
SCREEN-T1023-SCREENING 25 25.000000 1250.0000 50.0000
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 119 422.500000 27396.5500 64.8439
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 116 561.250000 28062.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 26.750000 1911.0200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 7 19.000000 1357.3600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 4 34.000000 1943.4400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 45 155.750000 11126.7800 71.4400
Subtotal (Total Children Is Unduplicated) 164 796.750000 44401.1000 55.7278
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Total 2466.250000 117834.9000 47.7790
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Number of Children (Unduplicated) With at Least One Service 549
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Center 52
Flag Claims Units Chgs Paid
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R 9 12.000000 750.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 893 912.500000 46314.7500 175.7500
P 1621 1371.500000 59648.3900 58429.3700
D 20 18.000000 1264.4800 0.0000
S 41 45.000000 2450.0000 0.0000
H 49 43.250000 2980.8600 0.0000
T 0 0.000000 0.0000 0.0000
73 64.000000 4426.4200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2706 2466.250000 117834.9000 58605.1200