CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 Page: 1
List order: No List
Payclass Filters:GR
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 58 72.500000 2697.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 31 38.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 23 63.500000 2362.2000 37.2000
Subtotal (Total Children Is Unduplicated) 58 174.000000 5059.2000 29.0759
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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 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.000000 600.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 22.000000 1221.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 13.000000 975.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 23 60.000000 3905.2500 65.0875
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EI Services,Class #03
INTR-T1013-INTERPRETER 2 5.250000 262.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 7.000000 70.0000 10.0000
TRAV-TRAVS-Travel by mile 28 2059.000000 916.1800 0.4450
Subtotal (Total Children Is Unduplicated) 29 2071.250000 1248.6800 0.6029
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Total 2305.250000 10213.1300 4.4304
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Number of Children (Unduplicated) With at Least One Service 59
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Center 02
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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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 44 1493.250000 2183.7900 2173.1100
3 118.000000 52.5100 0.0000
Other 358 694.000000 7976.8300 0.0000
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Total 405 2305.250000 10213.1300 2173.1100