CMS/EIP Fiscal Report Center: 06
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 1302 3190.750000 118057.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1302 3190.750000 118057.7500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 142 226.000000 16950.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 68 113.500000 8512.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 200 328.500000 18231.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 65 100.500000 7537.5000 75.0000
Subtotal (Total Children Is Unduplicated) 242 782.000000 52215.0000 66.7711
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 749 5683.500000 284175.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 37 122.750000 8769.2600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 12 45.500000 2574.0000 56.5714
PHY-97110-PT SESSION BY LICENSED PT 19 107.000000 7644.0600 71.4398
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 45 136.500000 9751.5600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 27.7600 13.8800
Subtotal (Total Children Is Unduplicated) 818 6097.250000 312941.6400 51.3250
-----------------------------------------------------------------------------------------------------------------------
Total 10070.000000 483214.3900 47.9855
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1444
-----------------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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
11703 10070.000000 483214.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11703 10070.000000 483214.3900 0.0000