CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 83 333.250000 12330.2500 37.0000
Subtotal (Total Children Is Unduplicated) 83 333.250000 12330.2500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 34.000000 2467.9000 72.5853
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 54.500000 3024.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 33 51.500000 3862.5000 75.0000
Subtotal (Total Children Is Unduplicated) 57 151.500000 10159.1500 67.0571
-----------------------------------------------------------------------------------------------------------------------
Total 484.750000 22489.4000 46.3938
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 83
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 1 2.000000 67.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 448 403.750000 17403.2500 17403.2500
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 57 79.000000 5018.2500 0.0000
---------------------------------------------------------
Total 506 484.750000 22489.4000 17403.2500