CMS/EIP Fiscal Report Center: 09
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 1143 4311.000000 159479.2500 36.9936
Subtotal (Total Children Is Unduplicated) 1143 4311.000000 159479.2500 36.9936
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 11.500000 862.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 61 109.000000 8175.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 25 46.000000 3450.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 10 17.500000 1312.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 127 242.000000 13381.0000 55.2934
Subtotal (Total Children Is Unduplicated) 186 443.500000 28298.5000 63.8072
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 18.000000 900.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 21 63.000000 3150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 27 81.000000 4050.0000 50.0000
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Total 4835.500000 191827.7500 39.6707
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Number of Children (Unduplicated) With at Least One Service 1146
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Center 09
Flag Claims Units Chgs Paid
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R 40 51.500000 2183.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 626 701.250000 27478.0000 0.0000
P 3914 4082.750000 162166.2500 162166.2500
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 4580 4835.500000 191827.7500 162166.2500