CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 62 40.250000 1497.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 47 193.750000 7207.5000 37.2000
Subtotal (Total Children Is Unduplicated) 76 234.000000 8704.8000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 2 6.000000 450.0000 75.0000
-----------------------------------------------------------------------------------------------------------------------
Total 240.000000 9154.8000 38.1450
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 76
-----------------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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 0 0.000000 0.0000 0.0000
297 232.000000 8857.2000 0.0000
Other 8 8.000000 297.6000 0.0000
---------------------------------------------------------
Total 305 240.000000 9154.8000 0.0000