CMS/EIP Fiscal Report Center: 03
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 600 1402.000000 52154.4000 37.2000
Subtotal (Total Children Is Unduplicated) 600 1402.000000 52154.4000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 55.000000 3052.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 34 65.500000 3765.0000 57.4809
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 27.500000 1350.0000 49.0909
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 4.250000 212.5000 50.0000
Subtotal (Total Children Is Unduplicated) 7 31.750000 1562.5000 49.2126
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Total 1499.250000 57481.9000 38.3404
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Number of Children (Unduplicated) With at Least One Service 603
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Center 03
Flag Claims Units Chgs Paid
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R 49 63.500000 2362.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 1969 1331.000000 50937.6500 0.0000
P 175 104.750000 4182.0500 4111.3500
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 2193 1499.250000 57481.9000 4111.3500