CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2017 ending 06/30/2018 Date of Report:08/10/2018 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1674 8034.000000 296861.2500 36.9506
Subtotal (Total Children Is Unduplicated) 1674 8034.000000 296861.2500 36.9506
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 40 80.000000 6000.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 24 46.000000 3450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 28 53.500000 4012.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 39 78.000000 4329.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 80 133.500000 9937.5000 74.4382
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 39 68.500000 5137.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 22 33.500000 2512.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 295 483.513510 26834.9998 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 436 785.000000 58875.0000 75.0000
Subtotal (Total Children Is Unduplicated) 692 1765.513510 121388.9998 68.7556
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 24 41.000000 1025.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 460 4691.500000 234575.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 4.000000 285.7600 71.4400
Subtotal (Total Children Is Unduplicated) 465 4736.500000 235885.7600 49.8017
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Total 14536.013510 654136.0098 45.0011
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Number of Children (Unduplicated) With at Least One Service 1715
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Center 53
Flag Claims Units Chgs Paid
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R 2 1.500000 68.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 368 246.000000 9310.7500 9.2500
P 15065 14288.513510 644756.7598 644701.2600
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 15435 14536.013510 654136.0098 644710.5100