CMS/EIP Fiscal Report Center: 03
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 30 36.250000 1348.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 86 286.250000 10647.4000 37.1962
Subtotal (Total Children Is Unduplicated) 90 322.500000 11995.9000 37.1966
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.000000 1125.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 19.000000 1425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 43 80.500000 4467.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
Subtotal (Total Children Is Unduplicated) 53 130.000000 8151.0000 62.7000
-----------------------------------------------------------------------------------------------------------------------
Total 452.500000 20146.9000 44.5235
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 94
-----------------------------------------------------------------------------------------------------------------------
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 70 98.250000 3997.1500 0.0000
P 27 48.000000 3312.3000 3312.3000
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 0 0.000000 0.0000 0.0000
227 269.500000 11415.4500 0.0000
Other 33 36.750000 1422.0000 0.0000
---------------------------------------------------------
Total 357 452.500000 20146.9000 3312.3000