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
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 1477 7227.500000 267020.7500 36.9451
Subtotal (Total Children Is Unduplicated) 1477 7227.500000 267020.7500 36.9451
-----------------------------------------------------------------------------------------------------------------------
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 52 99.000000 7350.0000 74.2424
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 30 56.000000 4200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 99 199.000000 11044.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 65 113.500000 8437.5000 74.3392
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 54 92.500000 6937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 25.500000 1912.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 431 736.527020 40821.7496 55.4246
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 413 733.500000 54973.5000 74.9468
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 634 2140.527020 142028.2996 66.3520
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 362.5500 362.5500
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 3 4.000000 293.2800 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 28 48.000000 1200.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 956 11921.00000 596050.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 72.000000 5143.6800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 3 17.000000 972.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
Subtotal (Total Children Is Unduplicated) 963 12065.00000 604164.7900 50.0758
-----------------------------------------------------------------------------------------------------------------------
Total 21433.027020 1013213.8396 47.2735
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1543
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 68.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 329 214.750000 8097.5000 0.0000
P 13775 12897.263510 579585.0098 579529.5100
D 0 0.000000 0.0000 0.0000
S 13 11.000000 510.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7997 8308.513510 424952.8298 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22116 21433.027020 1013213.8396 579529.5100