CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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 1053 3318.500000 122729.0000 36.9833
Subtotal (Total Children Is Unduplicated) 1053 3318.500000 122729.0000 36.9833
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 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 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 82 147.000000 8158.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 87 207.000000 15525.0000 75.0000
SCREEN-T1023-SCREENING 22 22.000000 1100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 147 411.000000 27018.5000 65.7384
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 34.500000 1725.0000 50.0000
Subtotal (Total Children Is Unduplicated) 10 34.500000 1725.0000 50.0000
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Total 3764.000000 151472.5000 40.2424
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Number of Children (Unduplicated) With at Least One Service 1053
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Center 07
Flag Claims Units Chgs Paid
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R 6 4.750000 175.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 213 141.500000 5387.2500 0.0000
P 4892 3594.750000 144988.5000 144951.5000
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
23 23.000000 921.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5134 3764.000000 151472.5000 144951.5000