CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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 1060 3301.750000 122146.2500 36.9944
Subtotal (Total Children Is Unduplicated) 1060 3301.750000 122146.2500 36.9944
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 11.000000 825.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.500000 487.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 11.500000 638.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 82 117.500000 8732.5000 74.3191
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 103 133.500000 9987.5000 74.8127
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 37.000000 2775.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 176 257.000000 14111.0200 54.9067
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 53.500000 4012.5000 75.0000
Subtotal (Total Children Is Unduplicated) 292 634.500000 42094.2700 66.3424
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 77 356.500000 17825.0000 50.0000
Subtotal (Total Children Is Unduplicated) 77 356.500000 17825.0000 50.0000
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Total 4292.750000 182065.5200 42.4123
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Number of Children (Unduplicated) With at Least One Service 1077
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Center 09
Flag Claims Units Chgs Paid
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R 2 3.500000 129.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 229 209.250000 8238.2500 27.7500
P 4077 4080.000000 173697.7700 173697.7700
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 4308 4292.750000 182065.5200 173725.5200