CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 Page: 1
List order: No List
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 988 3106.750000 114931.2500 36.9940
Subtotal (Total Children Is Unduplicated) 988 3106.750000 114931.2500 36.9940
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.500000 787.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 76 113.000000 8395.0000 74.2920
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 83 109.500000 8187.5000 74.7717
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 81 128.000000 9600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 140 210.000000 11502.5200 54.7739
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 76 109.000000 8150.0000 74.7706
Subtotal (Total Children Is Unduplicated) 230 710.500000 48734.5200 68.5919
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 727 5140.500000 257025.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 48 442.000000 31576.4800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 76 582.000000 41578.0800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 76 632.000000 45150.0800 71.4400
Subtotal (Total Children Is Unduplicated) 832 6796.500000 375329.6400 55.2240
-----------------------------------------------------------------------------------------------------------------------
Total 10613.750000 538995.4100 50.7827
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1108
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 3.500000 129.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 220 191.750000 7419.7500 27.7500
P 3857 3758.500000 157651.7700 157651.7700
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
2005 6446.500000 357992.1400 0.0000
Other 142 213.500000 15802.2500 0.0000
---------------------------------------------------------
Total 6226 10613.750000 538995.4100 157679.5200