CMS/EIP Fiscal Report Center: 09
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 1203 4097.500000 151431.7500 36.9571
Subtotal (Total Children Is Unduplicated) 1203 4097.500000 151431.7500 36.9571
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 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 124 200.500000 15037.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 39 63.500000 4762.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 77 136.000000 10200.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 143 248.500000 13791.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 71 110.500000 8287.5000 75.0000
Subtotal (Total Children Is Unduplicated) 226 772.000000 53025.0000 68.6852
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 842 5799.000000 289650.0000 49.9483
OCCT-97530-OT SESSION BY LICENSED OT 42 312.000000 22289.2800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 66 491.000000 35077.0400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 130 924.000000 66010.5600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
Subtotal (Total Children Is Unduplicated) 981 7530.000000 413082.4000 54.8582
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Total 12399.500000 617539.1500 49.8036
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Number of Children (Unduplicated) With at Least One Service 1346
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Center 09
Flag Claims Units Chgs Paid
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R 189 222.750000 8241.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1700 1599.250000 62514.0000 124.5000
P 2889 2918.500000 120148.2500 120038.3300
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
2387 7390.000000 406975.9000 0.0000
Other 160 269.000000 19659.2500 0.0000
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Total 7325 12399.500000 617539.1500 120162.8300