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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 665 1574.000000 58552.8000 37.2000
Subtotal (Total Children Is Unduplicated) 665 1574.000000 58552.8000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 34 64.000000 3552.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.000000 975.0000 75.0000
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 41 80.000000 4677.0000 58.4625
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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 1692.500000 65129.8000 38.4814
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Number of Children (Unduplicated) With at Least One Service 671
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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 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
8 11.000000 464.1000 0.0000
Other 184 168.750000 6473.7000 0.0000
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Total 2403 1692.500000 65129.8000 4111.3500