CMS/EIP Fiscal Report Center: 05
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 Page: 1
List order: No List
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 674 1914.250000 70827.2500 37.0000
Subtotal (Total Children Is Unduplicated) 674 1914.250000 70827.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 6.000000 450.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 23 35.500000 2662.5000 75.0000
Subtotal (Total Children Is Unduplicated) 32 45.500000 3412.5000 75.0000
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EI Services,Class #03
PHY-97110-PT SESSION BY LICENSED PT 1 0.750000 53.5800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 2 6.000000 428.6400 71.4400
Subtotal (Total Children Is Unduplicated) 2 6.750000 482.2200 71.4400
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Total 1966.500000 74721.9700 37.9974
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Number of Children (Unduplicated) With at Least One Service 674
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Center 05
Flag Claims Units Chgs Paid
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R 26 31.000000 1934.3200 0.0000
U 0 0.000000 0.0000 0.0000
B 3054 1930.750000 72554.9000 41748.7500
P 0 0.000000 0.0000 0.0000
D 1 1.500000 112.5000 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
5 3.250000 120.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3086 1966.500000 74721.9700 41748.7500