CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
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 537 1389.250000 51245.0000 36.8868
Subtotal (Total Children Is Unduplicated) 537 1389.250000 51245.0000 36.8868
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 80 157.000000 11765.0000 74.9363
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 48 95.000000 7125.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 32.500000 2437.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 94 185.000000 10247.7500 55.3932
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 24.000000 1800.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 22 22.000000 1100.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 713.6500 50.9750
Subtotal (Total Children Is Unduplicated) 141 563.500000 37418.0000 66.4028
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 259 1543.500000 77025.0000 49.9028
OCCT-97530-OT SESSION BY LICENSED OT 44 196.750000 14031.4600 71.3162
OCCT-97530HM-OT SESSION BY OT ASST 7 26.000000 1487.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 23 107.750000 7697.6600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 23.000000 1314.6800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 95 473.000000 33601.1200 71.0383
Subtotal (Total Children Is Unduplicated) 349 2370.000000 135157.1200 57.0283
-----------------------------------------------------------------------------------------------------------------------
Total 4322.750000 223820.1200 51.7773
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 581
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 66 73.750000 3978.2500 37.0000
P 2837 2568.500000 121432.7500 120124.5500
D 59 50.000000 2687.6100 0.0000
S 30 25.500000 1165.5000 0.0000
H 53 50.000000 3416.9800 0.0000
T 1 4.000000 200.0000 0.0000
780 1551.000000 90939.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3826 4322.750000 223820.1200 120161.5500