CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1018 3047.000000 112415.2500 36.8937
Subtotal (Total Children Is Unduplicated) 1018 3047.000000 112415.2500 36.8937
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 16.000000 1200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 130 241.000000 13375.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 117 263.500000 19762.5000 75.0000
SCREEN-T1023-SCREENING 14 14.000000 700.0000 50.0000
Subtotal (Total Children Is Unduplicated) 187 536.500000 35149.0000 65.5154
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9 25.500000 1275.0000 50.0000
Subtotal (Total Children Is Unduplicated) 9 25.500000 1275.0000 50.0000
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Total 3609.000000 148839.2500 41.2411
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Number of Children (Unduplicated) With at Least One Service 1030
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Center 07
Flag Claims Units Chgs Paid
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R 28 18.000000 666.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 71 47.250000 1828.0000 0.0000
P 4612 3543.750000 146345.2500 146214.2500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4711 3609.000000 148839.2500 146214.2500