CMS/EIP Fiscal Report Center: 57
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 56 30.500000 1128.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 150 1226.500000 45356.4500 36.9804
Subtotal (Total Children Is Unduplicated) 151 1257.000000 46484.9500 36.9809
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 74 115.500000 8583.2500 74.3139
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 27 47.000000 3447.0000 73.3404
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 30 48.000000 3541.5000 73.7813
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 105 175.000000 9687.5000 55.3571
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 27.000000 2025.0000 75.0000
Subtotal (Total Children Is Unduplicated) 134 435.000000 28796.2500 66.1983
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Total 1692.000000 75281.2000 44.4924
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Number of Children (Unduplicated) With at Least One Service 151
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Center 57
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 112 214.250000 9352.5000 0.0000
P 197 356.750000 17383.2500 17383.2500
D 0 0.000000 0.0000 0.0000
S 1 1.500000 83.2500 83.2500
H 0 0.000000 0.0000 0.0000
T 3 5.250000 260.0000 20.3500
502 1112.750000 48118.9500 0.0000
Other 1 1.500000 83.2500 0.0000
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Total 816 1692.000000 75281.2000 17486.8500