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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1022 608.500000 22505.5000 36.9852
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 4.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 778 1781.500000 65915.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1434 2394.000000 88421.0000 36.9344
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 13 21.000000 1575.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 12.000000 900.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 11.500000 638.2500 55.5000
Subtotal (Total Children Is Unduplicated) 14 46.000000 3225.7500 70.1250
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Total 2440.000000 91646.7500 37.5601
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Number of Children (Unduplicated) With at Least One Service 1434
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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 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 0 0.000000 0.0000 0.0000
4245 2298.750000 86420.5000 0.0000
Other 192 141.250000 5226.2500 0.0000
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Total 4437 2440.000000 91646.7500 0.0000