CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 2233 6504.500000 240666.5000 37.0000
Subtotal (Total Children Is Unduplicated) 2233 6504.500000 240666.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 224 403.500000 30262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 111 190.500000 14258.2500 74.8465
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 92.000000 6900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 249 448.500000 24891.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 54.500000 4087.5000 75.0000
Subtotal (Total Children Is Unduplicated) 331 1219.000000 82406.2500 67.6015
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Total 7723.500000 323072.7500 41.8298
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Number of Children (Unduplicated) With at Least One Service 2234
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Center 10
Flag Claims Units Chgs Paid
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R 180 151.000000 5587.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3445 2783.250000 114456.2500 18.5000
P 5902 4773.250000 202437.5000 201709.9580
D 6 6.250000 231.2500 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
10 9.250000 342.2500 0.0000
Other 1 0.500000 18.5000 0.0000
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Total 9544 7723.500000 323072.7500 201728.4580