CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2018 ending 06/30/2019 Date of Report:07/21/2019 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 204 1042.000000 38498.5000 36.9467
Subtotal (Total Children Is Unduplicated) 204 1042.000000 38498.5000 36.9467
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.500000 562.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 15.500000 860.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 52.500000 3862.5000 73.5714
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 32.000000 2400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 23.000000 1725.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 143 218.000000 11988.0000 54.9908
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 116 185.000000 13875.0000 75.0000
Subtotal (Total Children Is Unduplicated) 190 547.500000 36323.2500 66.3438
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1 2.000000 100.0000 50.0000
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Total 1591.500000 74921.7500 47.0762
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Number of Children (Unduplicated) With at Least One Service 207
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Center 53
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 368 387.500000 17233.2500 27.7500
P 915 1019.000000 46699.0000 46717.0500
D 8 8.000000 314.5000 0.0000
S 21 24.500000 888.0000 851.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
104 152.500000 9787.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1416 1591.500000 74921.7500 47595.8000