CMS/EIP Fiscal Report Center: 09
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 122 300.750000 11127.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 175 452.750000 16751.7500 37.0000
Subtotal (Total Children Is Unduplicated) 184 753.500000 27879.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 15.500000 860.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 80 133.500000 9912.5000 74.2509
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 55 95.000000 7075.0000 74.4737
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 42 70.500000 5287.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 138 234.000000 12847.0000 54.9017
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 24.500000 1837.5000 75.0000
Subtotal (Total Children Is Unduplicated) 170 595.500000 39478.0000 66.2939
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EI Services,Class #03
INTR-T1013-INTERPRETER 8 32.250000 1612.5000 50.0000
Subtotal (Total Children Is Unduplicated) 8 32.250000 1612.5000 50.0000
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Total 1381.250000 68970.0000 49.9330
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Number of Children (Unduplicated) With at Least One Service 187
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Center 09
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 9 14.250000 789.2500 0.0000
P 651 939.000000 42277.2500 42343.2900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 150 220.500000 12428.2500 0.0000
T 2 4.000000 300.0000 300.0000
79 135.000000 8453.0000 0.0000
Other 39 68.500000 4722.2500 0.0000
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Total 930 1381.250000 68970.0000 42643.2900