CMS/EIP Fiscal Report Center: 06
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 124 73.000000 2691.7500 36.8733
TCM-T1017TL-TARGETED CASE MANAGEMENT 104 406.500000 15040.5000 37.0000
Subtotal (Total Children Is Unduplicated) 169 479.500000 17732.2500 36.9807
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 11.000000 825.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 -112.5000 0.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 -83.2500 0.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 10.000000 555.0000 55.5000
Subtotal (Total Children Is Unduplicated) 10 30.000000 1634.2500 54.4750
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 14 27.000000 270.0000 10.0000
Subtotal (Total Children Is Unduplicated) 14 27.000000 270.0000 10.0000
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Total 536.500000 19636.5000 36.6011
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Number of Children (Unduplicated) With at Least One Service 173
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Center 06
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 27 29.000000 230.0000 230.0000
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 0 0.000000 0.0000 0.0000
536 475.500000 18222.5000 0.0000
Other 38 32.000000 1184.0000 0.0000
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Total 601 536.500000 19636.5000 230.0000