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
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 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 3 6.000000 450.0000 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 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 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 79 113.500000 8497.5000 74.8678
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 29 41.500000 3087.5000 74.3976
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 115 194.000000 10678.2000 55.0423
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 35 55.000000 4090.0000 74.3636
Subtotal (Total Children Is Unduplicated) 216 468.000000 31075.2000 66.4000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 41 200.500000 10025.0000 50.0000
Subtotal (Total Children Is Unduplicated) 41 200.500000 10025.0000 50.0000
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Total 3876.000000 159777.7000 41.2223
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Number of Children (Unduplicated) With at Least One Service 998
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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 3668 3848.250000 158776.7500 159687.2500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3695 3876.000000 159777.7000 159737.2500