CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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
TCM-T1017TL-TARGETED CASE MANAGEMENT 13 52.750000 1951.7500 37.0000
Subtotal (Total Children Is Unduplicated) 13 52.750000 1951.7500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 19 29.500000 2212.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 8.000000 600.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 46 65.500000 3635.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 52.000000 3900.0000 75.0000
Subtotal (Total Children Is Unduplicated) 70 175.000000 11711.2500 66.9214
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-T1013-INTERPRETER 12 19.250000 962.5000 50.0000
Subtotal (Total Children Is Unduplicated) 12 19.250000 962.5000 50.0000
-----------------------------------------------------------------------------------------------------------------------
Total 247.000000 14625.5000 59.2126
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 82
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 23 34.250000 2122.7500 2122.7500
D 10 16.500000 1056.5000 0.0000
S 59 74.500000 3888.5000 0.0000
H 5 6.000000 391.5000 0.0000
T 24 37.000000 2228.5000 2228.5000
34 47.250000 2874.5000 0.0000
Other 23 31.500000 2063.2500 0.0000
---------------------------------------------------------
Total 178 247.000000 14625.5000 4351.2500