CMS/EIP Fiscal Report Center: 57
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 439 252.750000 9351.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1286 6481.000000 239279.0000 36.9201
Subtotal (Total Children Is Unduplicated) 1325 6733.750000 248630.7500 36.9231
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 4 4.000000 200.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 12 20.000000 1500.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 11.500000 862.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 11.500000 812.5000 70.6522
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 8 12.500000 908.2500 72.6600
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 18 31.500000 1698.2500 53.9127
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 173 283.500000 20821.6700 73.4450
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 36 62.500000 4460.0000 71.3600
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 40 62.500000 4687.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 210 347.500000 18858.2500 54.2683
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 60.000000 4485.0000 74.7500
Subtotal (Total Children Is Unduplicated) 280 910.000000 59489.6700 65.3733
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Total 7643.750000 308120.4200 40.3101
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Number of Children (Unduplicated) With at Least One Service 1326
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Center 57
Flag Claims Units Chgs Paid
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R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 725 955.500000 40454.7500 0.0000
P 2075 2776.750000 114213.2500 114562.9400
D 0 0.000000 0.0000 0.0000
S 1 1.500000 112.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 68 161.500000 6271.4200 2577.9500
2448 3746.250000 146985.2500 0.0000
Other 2 1.750000 64.7500 0.0000
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Total 5320 7643.750000 308120.4200 117140.8900