CMS/EIP Fiscal Report Center: 04
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/20/2020 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 1265 5670.750000 209802.7500 36.9974
Subtotal (Total Children Is Unduplicated) 1265 5670.750000 209802.7500 36.9974
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 7.000000 350.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 6 20.000000 1428.8000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 22.000000 1571.6800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 0.500000 35.7200 71.4400
Subtotal (Total Children Is Unduplicated) 12 49.500000 3386.2000 68.4081
-----------------------------------------------------------------------------------------------------------------------
Total 5720.250000 213188.9500 37.2692
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1266
-----------------------------------------------------------------------------------------------------------------------
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 450 592.500000 21922.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 3026 4382.250000 162128.2500 0.0000
P 552 745.500000 29138.2000 25866.4200
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
---------------------------------------------------------
Total 4028 5720.250000 213188.9500 25866.4200