CMS/EIP Fiscal Report Center: 04
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 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 1169 5439.250000 201237.2500 36.9972
Subtotal (Total Children Is Unduplicated) 1169 5439.250000 201237.2500 36.9972
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 9.000000 675.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 16 17.000000 1275.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 15 24.000000 1800.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 25 33.000000 1831.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 24 25.000000 1875.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 39 41.000000 3075.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 87 113.000000 6271.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 43.500000 3262.5000 75.0000
Subtotal (Total Children Is Unduplicated) 124 305.500000 20065.5000 65.6809
-----------------------------------------------------------------------------------------------------------------------
Total 5744.750000 221302.7500 38.5226
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1169
-----------------------------------------------------------------------------------------------------------------------
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 330 497.000000 18389.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2906 4249.000000 157198.0000 0.0000
P 528 688.250000 25465.2500 25420.8500
D 0 0.000000 0.0000 0.0000
S 1 2.000000 74.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
270 307.000000 20121.0000 0.0000
Other 1 1.500000 55.5000 0.0000
---------------------------------------------------------
Total 4036 5744.750000 221302.7500 25420.8500