CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2018 ending 09/30/2018 Date of Report:11/06/2018 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 659 1763.500000 65184.7500 36.9633
Subtotal (Total Children Is Unduplicated) 659 1763.500000 65184.7500 36.9633
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 21.000000 1575.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 25.000000 1875.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 26.000000 1950.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 18.000000 999.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 25.000000 1875.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 7.500000 562.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 17.500000 1312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 76 126.500000 7020.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 102 176.500000 13200.0000 74.7875
Subtotal (Total Children Is Unduplicated) 180 445.000000 30519.7500 68.5837
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 9.250000 231.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 254 1351.500000 67525.0000 49.9630
Subtotal (Total Children Is Unduplicated) 258 1360.750000 67756.2500 49.7933
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Total 3569.250000 163460.7500 45.7969
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Number of Children (Unduplicated) With at Least One Service 747
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Center 53
Flag Claims Units Chgs Paid
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R 160 157.000000 7242.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1075 1019.000000 45841.7500 0.0000
P 2481 2393.250000 110376.5000 110165.5000
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 3716 3569.250000 163460.7500 110165.5000