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
Payclass Filters:GR
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 49 152.250000 5660.8500 37.1813
Subtotal (Total Children Is Unduplicated) 97 358.000000 13314.7500 37.1920
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 13.500000 1012.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 17 30.000000 1665.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
Subtotal (Total Children Is Unduplicated) 26 74.000000 4896.7500 66.1723
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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 469.250000 20074.0000 42.7789
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Number of Children (Unduplicated) With at Least One Service 102
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Center 09
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 249 324.500000 14098.5000 14098.5000
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 113 141.250000 5713.0000 5713.0000
0 0.000000 0.0000 0.0000
Other 2 3.500000 262.5000 0.0000
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Total 364 469.250000 20074.0000 19811.5000