CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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 1289 5795.500000 214433.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1289 5795.500000 214433.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 11.000000 825.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 12.500000 937.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 28 36.000000 2700.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 34 42.500000 2358.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 69 50.500000 3787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 98 76.000000 5700.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 195 176.000000 9768.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 92 75.000000 5625.0000 75.0000
Subtotal (Total Children Is Unduplicated) 244 479.500000 31701.7500 66.1142
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Total 6275.000000 246135.2500 39.2247
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Number of Children (Unduplicated) With at Least One Service 1289
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Center 04
Flag Claims Units Chgs Paid
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R 34 49.750000 1840.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1103 1594.000000 61738.7500 101.7500
P 2533 3897.750000 150531.7500 150064.7900
D 1 1.000000 75.0000 0.0000
S 2 4.000000 148.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
559 722.500000 31579.0000 0.0000
Other 4 6.000000 222.0000 0.0000
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Total 4236 6275.000000 246135.2500 150166.5400