CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 Page: 1
List order: No List
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 1056 2604.000000 96264.7500 36.9680
Subtotal (Total Children Is Unduplicated) 1056 2604.000000 96264.7500 36.9680
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 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 4 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 74 145.500000 10912.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 83 162.000000 8991.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 86 180.000000 13500.0000 75.0000
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
Subtotal (Total Children Is Unduplicated) 158 516.500000 35282.2500 68.3103
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 13.000000 621.6400 47.8185
Subtotal (Total Children Is Unduplicated) 3 13.000000 621.6400 47.8185
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Total 3133.500000 132168.6400 42.1792
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Number of Children (Unduplicated) With at Least One Service 1060
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Center 07
Flag Claims Units Chgs Paid
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R 13 9.500000 351.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 40 36.000000 1421.0000 0.0000
P 3565 3057.750000 129078.3900 129013.6400
D 0 0.000000 0.0000 0.0000
S 8 8.000000 400.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
31 21.250000 880.7500 0.0000
Other 2 1.000000 37.0000 0.0000
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Total 3659 3133.500000 132168.6400 129013.6400