CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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 1839 4502.500000 166370.5000 36.9507
Subtotal (Total Children Is Unduplicated) 1839 4502.500000 166370.5000 36.9507
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 14.500000 1087.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 0.500000 27.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 64 98.500000 5466.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 213 355.500000 26662.5000 75.0000
Subtotal (Total Children Is Unduplicated) 254 471.000000 33394.5000 70.9013
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 129 320.250000 16012.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 21.000000 1500.2400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 19 48.000000 3429.1200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 2 3.000000 171.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 30.000000 2143.2000 71.4400
Subtotal (Total Children Is Unduplicated) 163 422.250000 23256.5400 55.0777
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Total 5395.750000 223021.5400 41.3328
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Number of Children (Unduplicated) With at Least One Service 1863
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Center 01
Flag Claims Units Chgs Paid
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R 616 441.250000 18223.0900 0.0000
U 0 0.000000 0.0000 0.0000
B 744 823.000000 50248.6200 0.0000
P 6372 4131.500000 154549.8300 151640.2800
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 7732 5395.750000 223021.5400 151640.2800