CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 834 2970.250000 109899.2500 37.0000
Subtotal (Total Children Is Unduplicated) 834 2970.250000 109899.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 127 252.000000 18900.0000 75.0000
Subtotal (Total Children Is Unduplicated) 133 264.000000 19800.0000 75.0000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 43 226.250000 11312.5000 50.0000
Subtotal (Total Children Is Unduplicated) 43 226.250000 11312.5000 50.0000
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Total 3460.500000 141011.7500 40.7490
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Number of Children (Unduplicated) With at Least One Service 835
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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 3 1.250000 46.2500 0.0000
P 3894 3459.250000 140965.5000 140965.5000
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 3897 3460.500000 141011.7500 140965.5000