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
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 988 3106.750000 114931.2500 36.9940
Subtotal (Total Children Is Unduplicated) 988 3106.750000 114931.2500 36.9940
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 525.0000 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 61 89.000000 6595.0000 74.1011
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 15 25.500000 1912.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 135 202.500000 11086.2700 54.7470
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 39.000000 2925.0000 75.0000
Subtotal (Total Children Is Unduplicated) 222 494.000000 32668.2700 66.1301
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 77 357.500000 17875.0000 50.0000
Subtotal (Total Children Is Unduplicated) 77 357.500000 17875.0000 50.0000
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Total 3958.250000 165474.5200 41.8050
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Number of Children (Unduplicated) With at Least One Service 1000
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Center 09
Flag Claims Units Chgs Paid
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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
1 1.000000 50.0000 0.0000
Other 2 3.500000 223.5000 0.0000
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Total 4082 3958.250000 165474.5200 157679.5200