CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 65 95.000000 3515.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 9 8.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 19 53.000000 1961.0000 37.0000
Subtotal (Total Children Is Unduplicated) 67 156.750000 5476.0000 34.9346
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.500000 187.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 7.500000 416.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 12 26.000000 1706.2500 65.6250
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EI Services,Class #03
INTR-T1013-INTERPRETER 2 6.750000 337.5000 50.0000
TRAV-TRAVS-Travel by mile 11 770.000000 342.6300 0.4450
Subtotal (Total Children Is Unduplicated) 13 776.750000 680.1300 0.8756
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Total 959.500000 7862.3800 8.1942
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Number of Children (Unduplicated) With at Least One Service 68
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Center 02
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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 22 723.250000 842.7100 842.7100
2 56.000000 24.9200 0.0000
Other 340 180.250000 6994.7500 0.0000
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Total 364 959.500000 7862.3800 842.7100