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
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 1794 4310.750000 159275.7500 36.9485
Subtotal (Total Children Is Unduplicated) 1794 4310.750000 159275.7500 36.9485
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 3.000000 51.5500 17.1833
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.500000 862.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 56 92.500000 6937.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 195 306.000000 16983.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 208 358.000000 26850.0000 75.0000
Subtotal (Total Children Is Unduplicated) 258 780.000000 52252.3000 66.9901
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 223 546.250000 27312.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 21.000000 1500.2400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 35 78.000000 5572.3200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 2 3.000000 171.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 38.000000 2696.8600 70.9700
Subtotal (Total Children Is Unduplicated) 272 686.250000 37253.4000 54.2855
-----------------------------------------------------------------------------------------------------------------------
Total 5777.000000 248781.4500 43.0641
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1844
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 600 432.250000 17890.0900 0.0000
U 0 0.000000 0.0000 0.0000
B 700 769.750000 46448.6200 0.0000
P 6132 3936.000000 147316.3300 144406.7800
D 120 119.000000 5885.8300 0.0000
S 11 14.500000 861.1300 0.0000
H 2 1.000000 37.0000 37.0000
T 1 0.750000 27.7500 0.0000
8 2.250000 83.2500 0.0000
Other 377 501.500000 30231.4500 0.0000
---------------------------------------------------------
Total 7951 5777.000000 248781.4500 144443.7800