CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2016 ending 06/30/2017 Date of Report:08/05/2017 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1655 8905.750000 328755.2500 36.9149
Subtotal (Total Children Is Unduplicated) 1655 8905.750000 328755.2500 36.9149
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 47 92.500000 6937.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 58 117.000000 8775.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 38 68.500000 5137.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 84 155.500000 8630.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 81 128.500000 9637.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 54.000000 4050.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 39.500000 2962.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 425 701.500000 38877.7500 55.4209
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 462 811.000000 60787.5000 74.9538
Subtotal (Total Children Is Unduplicated) 741 2169.500000 145908.0000 67.2542
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 20 72.000000 1800.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 494 5457.075000 272853.7500 50.0000
Subtotal (Total Children Is Unduplicated) 504 5529.075000 274653.7500 49.6744
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Total 16604.325000 749317.0000 45.1278
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Number of Children (Unduplicated) With at Least One Service 1713
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Center 53
Flag Claims Units Chgs Paid
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R 30 29.250000 1228.7500 721.5000
U 0 0.000000 0.0000 0.0000
B 1029 944.500000 42270.5000 6456.5000
P 16403 15630.575000 705817.7500 705711.7500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 17462 16604.325000 749317.0000 712889.7500