CMS/EIP Fiscal Report Center: 04
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 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 1087 4512.500000 167865.0000 37.2000
Subtotal (Total Children Is Unduplicated) 1087 4512.500000 167865.0000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 0.500000 37.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 84 100.500000 7537.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 103 139.500000 7742.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 76.500000 5737.5000 75.0000
Subtotal (Total Children Is Unduplicated) 117 329.500000 21933.7500 66.5668
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 10.000000 500.0000 50.0000
Subtotal (Total Children Is Unduplicated) 3 10.000000 500.0000 50.0000
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Total 4852.000000 190298.7500 39.2207
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Number of Children (Unduplicated) With at Least One Service 1098
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Center 04
Flag Claims Units Chgs Paid
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R 210 326.500000 12902.5500 0.0000
U 0 0.000000 0.0000 0.0000
B 2014 3254.750000 126793.8000 0.0000
P 769 1270.750000 50602.4000 50212.8000
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 2993 4852.000000 190298.7500 50212.8000