CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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 1913 6484.000000 241362.9000 37.2244
Subtotal (Total Children Is Unduplicated) 1913 6484.000000 241362.9000 37.2244
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 13.000000 975.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 225.0000 56.2500
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.500000 527.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 259 476.000000 35737.5000 75.0788
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 76 141.500000 10612.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 55 93.500000 7050.0000 75.4011
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 35 60.000000 4500.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 67 101.500000 7800.0000 76.8473
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 12.500000 937.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 193 358.000000 19785.7500 55.2675
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 75 139.000000 7714.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 79 131.500000 9862.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
Subtotal (Total Children Is Unduplicated) 399 1566.000000 107609.2500 68.7160
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 11.000000 550.0000 50.0000
OCCT-97530HM-OT SESSION BY OT ASST 1 4.000000 230.4000 57.6000
Subtotal (Total Children Is Unduplicated) 3 15.000000 780.4000 52.0267
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Total 8065.000000 349752.5500 43.3667
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Number of Children (Unduplicated) With at Least One Service 1915
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Center 10
Flag Claims Units Chgs Paid
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R 47 32.750000 1218.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 8893 8006.750000 347005.3500 0.0000
P 17 25.500000 1528.9000 132.0000
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 8957 8065.000000 349752.5500 132.0000