CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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 955 3207.500000 118677.5000 37.0000
Subtotal (Total Children Is Unduplicated) 955 3207.500000 118677.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 118 181.000000 13560.0000 74.9171
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 42.000000 3150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 92 150.000000 11225.0000 74.8333
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 134 224.500000 12370.9500 55.1045
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 88 132.000000 9865.0000 74.7348
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 239 762.000000 52506.5000 68.9062
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 740 5264.500000 263225.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 41 307.000000 21932.0800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 43 342.000000 24432.4800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 86 715.000000 51079.6000 71.4400
Subtotal (Total Children Is Unduplicated) 829 6629.500000 360694.1600 54.4074
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Total 10599.000000 531878.1600 50.1819
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Number of Children (Unduplicated) With at Least One Service 1154
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Center 09
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 27 27.750000 1000.9500 50.0000
P 3669 3849.750000 158889.2500 159799.7500
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
2061 6479.500000 354237.7100 0.0000
Other 150 242.000000 17750.2500 0.0000
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Total 5907 10599.000000 531878.1600 159849.7500