CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 1112 2737.250000 101065.5000 36.9223
Subtotal (Total Children Is Unduplicated) 1112 2737.250000 101065.5000 36.9223
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 96 191.000000 14325.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 90 179.000000 9934.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 93 199.500000 14962.5000 75.0000
SCREEN-T1023-SCREENING 7 9.000000 450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 183 584.500000 40044.0000 68.5098
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Total 3321.750000 141109.5000 42.4805
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Number of Children (Unduplicated) With at Least One Service 1119
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Center 07
Flag Claims Units Chgs Paid
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R 112 128.500000 4767.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 596 508.000000 20658.2500 0.0000
P 2900 2605.000000 112601.5000 112578.9500
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
108 80.250000 3082.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3716 3321.750000 141109.5000 112578.9500