CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 2324 6875.000000 254210.5000 36.9761
Subtotal (Total Children Is Unduplicated) 2324 6875.000000 254210.5000 36.9761
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 13.500000 1012.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 13.000000 721.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 210 384.500000 28837.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 110 191.500000 14362.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 61 103.500000 7762.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 210 390.500000 21672.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 33 63.000000 4725.0000 75.0000
Subtotal (Total Children Is Unduplicated) 300 1169.000000 79767.7500 68.2359
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 7.000000 350.0000 50.0000
PHY-97110GT-PT SESSION BY LICENSED PT 1 0.500000 35.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 6.000000 428.6400 71.4400
Subtotal (Total Children Is Unduplicated) 5 13.500000 814.3600 60.3230
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Total 8057.500000 334792.6100 41.5504
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Number of Children (Unduplicated) With at Least One Service 2324
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Center 10
Flag Claims Units Chgs Paid
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R 139 107.500000 4459.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1084 814.500000 32311.0000 9.2500
P 8926 7135.500000 298022.3600 307781.3500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10149 8057.500000 334792.6100 307790.6000