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
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 1599 9014.250000 332684.1900 36.9065
Subtotal (Total Children Is Unduplicated) 1599 9014.250000 332684.1900 36.9065
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 49 96.500000 7237.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 57 115.500000 8662.5000 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 33 60.000000 4500.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 75 141.500000 7853.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 59 97.000000 7275.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 52.500000 3937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 41.500000 3112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 340 576.000000 31912.5000 55.4036
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 371 663.500000 49725.0000 74.9435
Subtotal (Total Children Is Unduplicated) 608 1845.500000 124328.2500 67.3683
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 8 17.000000 1246.4400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 20 73.000000 1825.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 506 5479.075000 273953.7500 50.0000
Subtotal (Total Children Is Unduplicated) 520 5569.075000 277025.1900 49.7435
-----------------------------------------------------------------------------------------------------------------------
Total 16428.825000 734037.6300 44.6799
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1611
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 22 22.000000 960.5000 592.0000
U 0 0.000000 0.0000 0.0000
B 940 852.500000 37700.5000 6003.2500
P 15487 14603.075000 658746.5000 658640.5000
D 0 0.000000 0.0000 0.0000
S 825 775.500000 28522.9400 28367.4400
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
224 171.500000 7935.9400 0.0000
Other 7 4.250000 171.2500 0.0000
---------------------------------------------------------
Total 17505 16428.825000 734037.6300 693603.1900