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
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 446 317.250000 11801.7000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 439 1043.250000 38807.1500 37.1983
Subtotal (Total Children Is Unduplicated) 741 1360.500000 50608.8500 37.1987
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 43 82.000000 4551.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 25.000000 1875.0000 75.0000
SCREEN-T1023-SCREENING 19 19.000000 950.0000 50.0000
Subtotal (Total Children Is Unduplicated) 79 137.500000 8102.0000 58.9236
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 11 18.000000 900.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 5 4.750000 237.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 9 11.500000 575.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 5.250000 262.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 23 61.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 28.000000 1400.0000 50.0000
TRAV-TRAVS-Travel by mile 1 1.000000 0.4400 0.4400
Subtotal (Total Children Is Unduplicated) 35 130.000000 3375.4400 25.9649
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Total 1628.000000 62086.2900 38.1365
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Number of Children (Unduplicated) With at Least One Service 775
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Center 03
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 1 1.000000 0.4400 0.4400
T 0 0.000000 0.0000 0.0000
2589 1624.500000 61952.6000 0.0000
Other 2 2.500000 133.2500 0.0000
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Total 2592 1628.000000 62086.2900 0.4400