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
Agency Filter:EIP DEI DEIP
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 586 1648.250000 60624.5000 36.7811
Subtotal (Total Children Is Unduplicated) 586 1648.250000 60624.5000 36.7811
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 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 10 20.000000 1110.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 74 147.500000 11062.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 40 78.500000 5887.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 19.000000 1425.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 92 182.500000 10128.7500 55.5000
SCREEN-T1023-SCREENING 20 20.000000 1000.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 151 486.500000 31966.9000 65.7079
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 161 817.750000 40887.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 34.000000 2428.9600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 39 192.500000 13752.2000 71.4400
Subtotal (Total Children Is Unduplicated) 196 1045.250000 57125.8200 54.6528
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Total 3180.000000 149717.2200 47.0809
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Number of Children (Unduplicated) With at Least One Service 609
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Center 52
Flag Claims Units Chgs Paid
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R 7 3.500000 142.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1012 990.250000 48275.2500 83.2500
P 2259 2085.500000 94863.5500 93920.2100
D 4 4.000000 221.4400 0.0000
S 6 7.000000 259.0000 0.0000
H 46 43.750000 2955.0300 0.0000
T 1 1.000000 50.0000 50.0000
51 45.000000 2950.4500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3386 3180.000000 149717.2200 94053.4600