CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 1716 4509.750000 166627.9900 36.9484
Subtotal (Total Children Is Unduplicated) 1716 4509.750000 166627.9900 36.9484
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 78 109.000000 8175.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 47.000000 3525.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 30 44.500000 3337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 36 50.500000 2802.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 34.500000 2587.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 179 317.000000 22689.1500 71.5746
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 50 223.500000 11175.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 15.000000 1071.6000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 3.000000 171.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 21 74.000000 5286.5600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 27 118.000000 8429.9200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 3 12.000000 166.5600 13.8800
Subtotal (Total Children Is Unduplicated) 98 445.500000 26301.2400 59.0376
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Total 5272.250000 215618.3800 40.8968
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Number of Children (Unduplicated) With at Least One Service 1724
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Center 01
Flag Claims Units Chgs Paid
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R 3 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 7275 4870.250000 192545.4600 0.0000
P 102 104.500000 5357.8000 5357.8000
D 56 56.000000 3943.0800 0.0000
S 162 138.750000 7062.4300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
82 100.500000 6569.3600 0.0000
Other 1 1.500000 112.5000 0.0000
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Total 7681 5272.250000 215618.3800 5357.8000