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: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 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 49 101.000000 7239.8100 71.6813
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 39.500000 2962.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 18.500000 1272.7900 68.7995
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 61 118.500000 6576.7500 55.5000
SCREEN-T1023-SCREENING 13 13.000000 650.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 93 306.500000 19775.9500 64.5219
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 62 308.250000 15299.5000 49.6334
OCCT-97530-OT SESSION BY LICENSED OT 11 51.500000 3632.7200 70.5383
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 35 174.000000 12005.6000 68.9977
Subtotal (Total Children Is Unduplicated) 106 533.750000 30937.8200 57.9631
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Total 854.250000 51231.7700 59.9728
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Number of Children (Unduplicated) With at Least One Service 174
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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 346 330.250000 19111.8100 12299.7200
197 220.250000 12100.8200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 758 854.250000 51231.7700 15645.7500