CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 Page: 1
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2 1.000000 37.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7 13.000000 481.0000 37.0000
Subtotal (Total Children Is Unduplicated) 8 14.000000 518.0000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 57 121.000000 8439.8100 69.7505
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 38 74.000000 5550.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 34.000000 2435.2900 71.6262
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 70 136.500000 7575.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 6.000000 300.0000 50.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 14 14.000000 700.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 100 414.500000 26804.3000 64.6666
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 110 600.500000 29712.0000 49.4788
OCCT-97530-OT SESSION BY LICENSED OT 43 169.500000 11241.0800 66.3191
OCCT-97530HM-OT SESSION BY OT ASST 14 72.250000 3903.9000 54.0332
PHY-97110-PT SESSION BY LICENSED PT 20 113.250000 7233.3000 63.8702
PHY-97110HM-PT SESSION BY PT ASST 1 5.000000 285.8000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 117 724.250000 46538.8800 64.2580
Subtotal (Total Children Is Unduplicated) 255 1684.750000 98914.9600 58.7120
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Total 2113.250000 126237.2600 59.7361
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Number of Children (Unduplicated) With at Least One Service 289
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Center 52
Flag Claims Units Chgs Paid
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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 69 67.750000 4673.8700 3286.0300
D 31 46.250000 2528.9100 60.0000
S 0 0.000000 0.0000 0.0000
H 115 189.750000 12816.3600 0.0000
T 755 1165.750000 69375.2100 62563.1200
426 643.750000 36842.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1396 2113.250000 126237.2600 65909.1500