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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 626 524.500000 19511.4000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 110 122.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 141 260.250000 9681.3000 37.2000
Subtotal (Total Children Is Unduplicated) 650 907.250000 29192.7000 32.1771
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
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 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 11.500000 862.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 35.500000 1914.7500 53.9366
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 14.000000 777.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 20.000000 1500.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.500000 1312.5000 75.0000
Subtotal (Total Children Is Unduplicated) 38 104.000000 6750.0000 64.9038
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 5 9.250000 462.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 8 8.000000 400.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 3.000000 150.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 10.500000 525.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 4 3.250000 162.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 53.000000 2650.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 10.000000 500.0000 50.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 3 2.750000 101.7500 37.0000
TRAV-TRAVS-Travel by mile 80 4830.000000 2148.9400 0.4449
Subtotal (Total Children Is Unduplicated) 98 4931.750000 7175.6900 1.4550
-----------------------------------------------------------------------------------------------------------------------
Total 5943.000000 43118.3900 7.2553
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 681
-----------------------------------------------------------------------------------------------------------------------
Center 02
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 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 1 2.250000 83.7000 71.9600
0 0.000000 0.0000 0.0000
Other 2285 5940.750000 43034.6900 0.0000
---------------------------------------------------------
Total 2286 5943.000000 43118.3900 71.9600