CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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 1013 3423.750000 126678.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1013 3423.750000 126678.7500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 96 135.500000 10147.5000 74.8893
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 33 49.500000 3712.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 42 60.500000 4512.5000 74.5868
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 149 253.500000 13980.4500 55.1497
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 45 70.000000 5215.0000 74.5000
Subtotal (Total Children Is Unduplicated) 285 594.500000 39363.4500 66.2127
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 41 200.500000 10025.0000 50.0000
Subtotal (Total Children Is Unduplicated) 41 200.500000 10025.0000 50.0000
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Total 4218.750000 176067.2000 41.7344
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Number of Children (Unduplicated) With at Least One Service 1072
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Center 09
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 28 29.750000 1150.9500 50.0000
P 3861 4189.000000 174916.2500 175826.7520
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 3889 4218.750000 176067.2000 175876.7520