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
Payclass Filters:GR
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 4 13.250000 490.2500 37.0000
Subtotal (Total Children Is Unduplicated) 4 13.250000 490.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 15.500000 860.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 11.000000 825.0000 75.0000
Subtotal (Total Children Is Unduplicated) 17 35.000000 2322.7500 66.3643
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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
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Total 67.500000 3775.5000 55.9333
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Number of Children (Unduplicated) With at Least One Service 31
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Center 01
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 0 0.000000 0.0000 0.0000
P 13 19.250000 1163.5000 1163.5000
D 1 1.000000 50.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 10 15.500000 820.7500 820.7500
23 31.750000 1741.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 47 67.500000 3775.5000 1984.2500