CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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 636 1474.250000 54837.0500 37.1966
Subtotal (Total Children Is Unduplicated) 636 1474.250000 54837.0500 37.1966
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.500000 187.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 76.000000 4218.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 10.000000 750.0000 75.0000
SCREEN-T1023-SCREENING 8 8.000000 400.0000 50.0000
Subtotal (Total Children Is Unduplicated) 59 102.500000 5888.5000 57.4488
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 11 45.000000 2250.0000 50.0000
Subtotal (Total Children Is Unduplicated) 11 45.000000 2250.0000 50.0000
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Total 1621.750000 62975.5500 38.8318
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Number of Children (Unduplicated) With at Least One Service 648
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Center 03
Flag Claims Units Chgs Paid
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R 46 27.500000 1023.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2134 1542.500000 59636.0000 0.0000
P 43 51.750000 2316.5500 2316.5500
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 2223 1621.750000 62975.5500 2316.5500