CMS/EIP Fiscal Report Center: 09
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
CASE-CASE-NON-TCM CASE MANAGEMENT 128 335.750000 12422.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 168 456.000000 16872.0000 37.0000
Subtotal (Total Children Is Unduplicated) 169 791.750000 29294.7500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 6.500000 487.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 14.000000 777.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 99 162.500000 12187.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 41 67.000000 5025.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 42 74.000000 5550.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.500000 527.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 134 221.500000 12293.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 21.000000 1575.0000 75.0000
Subtotal (Total Children Is Unduplicated) 169 598.500000 40110.0000 67.0175
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
INTR-T1013-INTERPRETER 8 17.000000 850.0000 50.0000
Subtotal (Total Children Is Unduplicated) 9 18.000000 900.0000 50.0000
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Total 1408.250000 70304.7500 49.9235
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Number of Children (Unduplicated) With at Least One Service 172
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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 40 63.250000 2983.5000 0.0000
P 530 747.000000 33828.0000 33869.3600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 132 185.000000 10688.0000 0.0000
T 1 2.000000 111.0000 0.0000
196 280.250000 13343.5000 0.0000
Other 72 130.750000 9350.7500 0.0000
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Total 971 1408.250000 70304.7500 33869.3600