CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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 3 1.250000 46.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 90 192.750000 7170.3000 37.2000
Subtotal (Total Children Is Unduplicated) 91 194.000000 7216.8000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 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 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 7.000000 525.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.500000 787.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 12.500000 693.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 12 16.500000 915.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 15.000000 1125.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 36.000000 2700.0000 75.0000
Subtotal (Total Children Is Unduplicated) 41 112.000000 7776.0000 69.4286
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
INTR-T1013-INTERPRETER 16 26.250000 1312.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 8.000000 80.0000 10.0000
TRAV-TRAVS-Travel by mile 4 70.000000 29.4400 0.4206
Subtotal (Total Children Is Unduplicated) 22 105.250000 1471.9400 13.9852
-----------------------------------------------------------------------------------------------------------------------
Total 411.250000 16464.7400 40.0358
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 104
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 18 60.750000 1043.8900 1043.8900
D 3 31.000000 162.0500 0.0000
S 185 158.000000 7459.8000 0.0000
H 15 18.000000 1223.2500 0.0000
T 21 28.000000 1226.7500 1226.7500
120 83.750000 3228.9000 0.0000
Other 25 31.750000 2120.1000 0.0000
---------------------------------------------------------
Total 387 411.250000 16464.7400 2270.6400