CMS/EIP Fiscal Report Center: 09
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 1077 4071.500000 150617.7500 36.9932
Subtotal (Total Children Is Unduplicated) 1077 4071.500000 150617.7500 36.9932
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 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 46 86.000000 6450.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 19 36.500000 2737.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 12.000000 900.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 79 151.000000 8330.5000 55.1689
Subtotal (Total Children Is Unduplicated) 124 310.500000 20098.0000 64.7279
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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 4463.000000 174765.7500 39.1588
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Number of Children (Unduplicated) With at Least One Service 1079
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Center 09
Flag Claims Units Chgs Paid
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R 39 50.500000 2146.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 593 638.000000 24876.2500 0.0000
P 3737 3761.500000 147262.0000 147262.0000
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 3 13.000000 481.0000 425.5000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4372 4463.000000 174765.7500 147687.5000