CMS/EIP Fiscal Report Center: 09
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 93 205.750000 7653.9000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 149 383.000000 14238.1000 37.1752
Subtotal (Total Children Is Unduplicated) 152 588.750000 21892.0000 37.1839
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 16.500000 915.7500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 84 138.500000 10387.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 44 70.500000 5287.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 24 44.000000 3300.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 128 210.000000 11630.0000 55.3810
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 26.000000 1950.0000 75.0000
Subtotal (Total Children Is Unduplicated) 153 523.000000 34783.2500 66.5072
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EI Services,Class #03
INTR-T1013-INTERPRETER 12 37.250000 1862.5000 50.0000
Subtotal (Total Children Is Unduplicated) 12 37.250000 1862.5000 50.0000
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Total 1149.000000 58537.7500 50.9467
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Number of Children (Unduplicated) With at Least One Service 156
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Center 09
Flag Claims Units Chgs Paid
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R 1 2.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 66 100.000000 4652.2000 166.8000
P 342 481.500000 21743.3500 21631.9200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 154 209.000000 11709.2500 0.0000
T 121 155.750000 6673.7500 6673.7500
60 113.250000 7456.2000 0.0000
Other 46 87.500000 6192.0000 0.0000
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Total 790 1149.000000 58537.7500 28472.4700