CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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 791 2580.500000 95469.2500 36.9964
Subtotal (Total Children Is Unduplicated) 791 2580.500000 95469.2500 36.9964
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 147 293.500000 22012.5000 75.0000
Subtotal (Total Children Is Unduplicated) 152 303.500000 22762.5000 75.0000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 42 225.500000 11275.0000 50.0000
Subtotal (Total Children Is Unduplicated) 42 225.500000 11275.0000 50.0000
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Total 3109.500000 129506.7500 41.6487
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Number of Children (Unduplicated) With at Least One Service 793
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Center 55
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 30 25.500000 943.5000 0.0000
P 3240 3084.000000 128563.2500 128563.2500
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 3270 3109.500000 129506.7500 128563.2500