CMS/EIP Fiscal Report Center: 07
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 64 63.000000 2343.5500 37.1992
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 11 9.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 73 189.750000 7054.5000 37.1779
Subtotal (Total Children Is Unduplicated) 80 262.250000 9398.0500 35.8362
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 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 1 2.000000 50.0000 25.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 20.000000 1500.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 40.000000 2220.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 12 24.000000 1332.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 14.000000 1050.0000 75.0000
Subtotal (Total Children Is Unduplicated) 49 148.000000 9557.0000 64.5743
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 9 12.750000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 11 16.000000 160.0000 10.0000
Subtotal (Total Children Is Unduplicated) 20 28.750000 160.0000 5.5652
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Total 439.000000 19115.0500 43.5423
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Number of Children (Unduplicated) With at Least One Service 91
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Center 07
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 48 56.500000 2891.4000 0.0000
P 107 143.400000 6680.2500 6680.2500
D 1 2.000000 150.0000 0.0000
S 3 1.250000 46.5000 0.0000
H 3 6.000000 450.0000 0.0000
T 0 0.000000 0.0000 0.0000
266 219.850000 8525.2000 0.0000
Other 12 10.000000 371.7000 0.0000
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Total 440 439.000000 19115.0500 6680.2500