CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
Payclass Filters:TPIN
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 1 0.500000 18.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1 0.500000 18.5000 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 80 128.500000 9637.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 47.500000 3562.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 43 67.500000 5062.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 81 132.000000 7326.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 126 397.000000 27000.3000 68.0108
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 11.8900 11.8900
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 206 1604.750000 78200.0000 48.7303
OCCT-97530-OT SESSION BY LICENSED OT 37 158.500000 10808.7600 68.1941
OCCT-97530HM-OT SESSION BY OT ASST 5 17.000000 972.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 52 204.750000 12395.9900 60.5421
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 142 667.000000 45093.2800 67.6061
SPL-92508-GROUP SPL SESSION PER CHILD 5 85.000000 908.4800 10.6880
Subtotal (Total Children Is Unduplicated) 389 2738.000000 148390.8000 54.1968
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Total 3135.500000 175409.6000 55.9431
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Number of Children (Unduplicated) With at Least One Service 459
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Center 06
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1993 1660.000000 90615.9600 90615.9600
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
1567 1475.500000 84793.6400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3560 3135.500000 175409.6000 90615.9600