CMS/EIP Fiscal Report Center: 10
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
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 3235 10343.75000 384683.2500 37.1899
Subtotal (Total Children Is Unduplicated) 3235 10343.75000 384683.2500 37.1899
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 17 28.500000 1425.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 24.000000 1800.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 7.000000 525.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 179 328.000000 24562.5000 74.8857
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 231 454.500000 34087.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 57 99.500000 7462.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 104 203.000000 15186.0000 74.8079
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 55 103.500000 7762.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 46 90.500000 6787.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 181 346.000000 19203.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 262 513.000000 28520.2500 55.5950
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 90 169.000000 12675.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 44.500000 3337.5000 75.0000
Subtotal (Total Children Is Unduplicated) 599 2449.500000 165880.5000 67.7201
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Total 12793.250000 550563.7500 43.0355
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Number of Children (Unduplicated) With at Least One Service 3243
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Center 10
Flag Claims Units Chgs Paid
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R 49 42.250000 1796.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 8174 7033.750000 297691.8000 0.0000
P 0 0.000000 0.0000 0.0000
D 105 132.000000 7839.9000 0.0000
S 380 220.750000 8324.1000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5426 4764.500000 209350.5000 0.0000
Other 635 600.000000 25561.3500 0.0000
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Total 14769 12793.250000 550563.7500 0.0000