CMS/EIP Fiscal Report Center: 03
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 191 231.000000 8593.2000 37.2000
Subtotal (Total Children Is Unduplicated) 191 231.000000 8593.2000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 17.500000 971.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.500000 487.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 13 27.000000 1658.7500 61.4352
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 7.000000 350.0000 50.0000
Subtotal (Total Children Is Unduplicated) 3 7.000000 350.0000 50.0000
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Total 265.000000 10601.9500 40.0074
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Number of Children (Unduplicated) With at Least One Service 196
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Center 03
Flag Claims Units Chgs Paid
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R 4 3.000000 111.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 217 133.750000 5157.2000 0.0000
P 158 128.250000 5333.1500 5333.9900
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 379 265.000000 10601.9500 5333.9900