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
Agency Filter:EIP DEI DEIP
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 1653 1945.500000 71928.0000 36.9715
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 66 80.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1610 3499.000000 129416.7500 36.9868
Subtotal (Total Children Is Unduplicated) 1970 5524.750000 201344.7500 36.4441
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 12 17.000000 850.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 12.000000 666.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 45 90.000000 6750.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 37 74.000000 5550.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 37.500000 2812.5000 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 79 158.000000 8769.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 58 116.000000 6438.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 118.500000 8887.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 43 88.000000 6600.0000 75.0000
Subtotal (Total Children Is Unduplicated) 253 731.000000 48745.0000 66.6826
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 39 77.250000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 39 77.250000 0.0000 0.0000
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Total 6333.000000 250089.7500 39.4899
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Number of Children (Unduplicated) With at Least One Service 1981
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Center 07
Flag Claims Units Chgs Paid
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R 4 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 375 302.500000 11944.5000 0.0000
P 2477 2083.204900 88663.8675 88395.8600
D 23 24.750000 1256.7500 0.0000
S 3 4.500000 318.5000 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
6705 3727.795100 140196.1325 0.0000
Other 308 178.250000 6886.0000 0.0000
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Total 9900 6333.000000 250089.7500 88395.8600