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
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 537 1389.250000 51245.0000 36.8868
Subtotal (Total Children Is Unduplicated) 537 1389.250000 51245.0000 36.8868
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 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 63 123.500000 9252.5000 74.9190
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 12 22.500000 1687.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 94 185.000000 10247.7500 55.3932
SCREEN-T1023-SCREENING 22 22.000000 1100.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 131 480.000000 31443.9500 65.5082
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 135 739.750000 36837.5000 49.7972
OCCT-97530-OT SESSION BY LICENSED OT 18 93.000000 6643.9200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 6 18.500000 1321.6400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 23.000000 1314.6800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 165.000000 11787.6000 71.4400
Subtotal (Total Children Is Unduplicated) 189 1039.250000 57905.3400 55.7184
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Total 2908.500000 140594.2900 48.3391
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Number of Children (Unduplicated) With at Least One Service 560
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Center 52
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 66 73.750000 3978.2500 37.0000
P 2836 2566.500000 121282.7500 119974.5500
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 0 0.000000 0.0000 0.0000
171 142.750000 8063.2000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3215 2908.500000 140594.2900 120011.5500