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
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 628 1449.250000 53912.1000 37.2000
Subtotal (Total Children Is Unduplicated) 628 1449.250000 53912.1000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 46.000000 2553.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 31 58.500000 3415.5000 58.3846
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 31.250000 1537.5000 49.2000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 7.250000 362.5000 50.0000
Subtotal (Total Children Is Unduplicated) 8 38.500000 1900.0000 49.3506
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Total 1546.250000 59227.6000 38.3040
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Number of Children (Unduplicated) With at Least One Service 632
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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 1884 1218.750000 46382.6000 0.0000
P 167 95.250000 3810.3500 3739.6500
D 18 13.500000 710.1000 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
7 9.500000 380.8500 0.0000
Other 169 145.750000 5581.5000 0.0000
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Total 2294 1546.250000 59227.6000 3739.6500