CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 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 105 160.250000 5929.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7 6.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 117 430.000000 15910.0000 37.0000
Subtotal (Total Children Is Unduplicated) 121 596.250000 21839.2500 36.6277
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 4.500000 337.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 28 46.500000 3487.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 5.500000 412.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 26 40.500000 3037.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 15 22.000000 1650.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 17.000000 943.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 63 100.000000 5550.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 12.500000 937.5000 75.0000
Subtotal (Total Children Is Unduplicated) 94 275.500000 18225.0000 66.1525
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 4 4.750000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7 8.000000 80.0000 10.0000
TRAV-TRAVS-Travel by mile 2 88.000000 39.1600 0.4450
Subtotal (Total Children Is Unduplicated) 7 100.750000 119.1600 1.1827
-----------------------------------------------------------------------------------------------------------------------
Total 972.500000 40183.4100 41.3197
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 122
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 6 11.000000 786.0000 0.0000
P 47 55.750000 3215.2500 3215.2500
D 2 1.000000 37.0000 0.0000
S 89 48.750000 1803.7500 0.0000
H 6 7.000000 316.0000 0.0000
T 5 91.500000 142.4100 142.4100
814 750.000000 33484.2500 0.0000
Other 5 6.500000 323.7500 0.0000
---------------------------------------------------------
Total 974 971.500000 40108.4100 3357.6600