CMS/EIP Fiscal Report Center: 57
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 862 3074.000000 113738.0000 37.0000
Subtotal (Total Children Is Unduplicated) 862 3074.000000 113738.0000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 146 139.000000 10425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 146 144.000000 7992.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 62 60.500000 4537.5000 75.0000
Subtotal (Total Children Is Unduplicated) 176 344.500000 23029.5000 66.8491
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Total 3418.500000 136767.5000 40.0080
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Number of Children (Unduplicated) With at Least One Service 862
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Center 57
Flag Claims Units Chgs Paid
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R 6 6.750000 249.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3493 3410.250000 136462.2500 0.0000
P 1 1.500000 55.5000 55.5000
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 3500 3418.500000 136767.5000 55.5000