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
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 90 358.500000 13264.5000 37.0000
Subtotal (Total Children Is Unduplicated) 90 358.500000 13264.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 47.500000 3562.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 12.500000 937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 10.500000 787.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 33 58.500000 3246.7500 55.5000
Subtotal (Total Children Is Unduplicated) 36 136.500000 9028.5000 66.1429
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Total 495.000000 22293.0000 45.0364
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Number of Children (Unduplicated) With at Least One Service 90
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Center 10
Flag Claims Units Chgs Paid
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R 1 1.250000 46.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 34 37.750000 1481.5000 0.0000
P 386 454.500000 20682.0000 20681.7500
D 1 1.500000 83.2500 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 422 495.000000 22293.0000 20681.7500