CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 Page: 1
List order: No List
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 105 133.750000 4948.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 19 20.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 117 363.750000 13403.2500 36.8474
Subtotal (Total Children Is Unduplicated) 122 518.250000 18352.0000 35.4115
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 812.5000 67.7083
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 70.000000 3885.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 38.000000 2109.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 44.000000 3300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 28.000000 2100.0000 75.0000
Subtotal (Total Children Is Unduplicated) 70 218.000000 13883.5000 63.6858
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 12 23.500000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 24 36.000000 360.0000 10.0000
Subtotal (Total Children Is Unduplicated) 36 59.500000 360.0000 6.0504
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Total 795.750000 32595.5000 40.9620
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Number of Children (Unduplicated) With at Least One Service 123
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Center 07
Flag Claims Units Chgs Paid
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R 8 9.500000 464.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 24 33.750000 1437.7500 0.0000
P 284 355.919100 15712.4325 15712.4300
D 1 2.000000 150.0000 0.0000
S 1 2.000000 150.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
473 369.830900 13763.0675 0.0000
Other 21 20.750000 767.7500 0.0000
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Total 813 795.750000 32595.5000 15712.4300