CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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 2102 7428.250000 276182.1000 37.1800
Subtotal (Total Children Is Unduplicated) 2102 7428.250000 276182.1000 37.1800
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 12.500000 937.5000 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-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 15.000000 832.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 80 145.500000 10837.5000 74.4845
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 112 217.500000 16312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 51.500000 3862.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 55 102.500000 7687.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 52 89.000000 6675.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 28 49.000000 3675.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 138 251.500000 13930.5000 55.3897
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 165 314.500000 17454.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 61 100.000000 7462.5000 74.6250
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 36.500000 2737.5000 75.0000
Subtotal (Total Children Is Unduplicated) 398 1416.000000 94593.7500 66.8035
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EI Services,Class #03
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 215.8800 71.9600
Subtotal (Total Children Is Unduplicated) 2 5.000000 359.8000 71.9600
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Total 8849.250000 371135.6500 41.9398
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Number of Children (Unduplicated) With at Least One Service 2107
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Center 10
Flag Claims Units Chgs Paid
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R 8 6.750000 251.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 10158 8837.500000 370524.7500 0.0000
P 2 5.000000 359.8000 40.0000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10168 8849.250000 371135.6500 40.0000