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
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 475 287.750000 10646.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1347 6481.250000 239780.3500 36.9960
Subtotal (Total Children Is Unduplicated) 1367 6769.000000 250427.1000 36.9962
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 15.500000 1162.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 12 22.000000 1221.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 176 317.500000 23762.5000 74.8425
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 57 107.000000 8025.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 51 89.000000 6556.7500 73.6713
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 240 435.500000 24070.2500 55.2704
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 57.000000 4148.2500 72.7763
Subtotal (Total Children Is Unduplicated) 297 1064.000000 70375.2500 66.1422
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Total 7833.000000 320802.3500 40.9552
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Number of Children (Unduplicated) With at Least One Service 1367
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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 850 1302.500000 53915.7500 0.0000
P 1685 2218.750000 93755.5000 102202.4700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5 4.250000 233.2500 59.6000
3254 4282.750000 171982.1000 0.0000
Other 27 24.750000 915.7500 0.0000
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Total 5821 7833.000000 320802.3500 102262.0700