CMS/EIP Fiscal Report Center: 55
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 961 1004.000000 37339.4000 37.1906
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 85 53.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 577 1464.250000 54422.2000 37.1673
Subtotal (Total Children Is Unduplicated) 1077 2521.500000 91761.6000 36.3917
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 20 42.000000 2100.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 5 10.000000 500.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 5 7.000000 350.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 33.060933 2479.5700 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 22.000000 1221.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 56 122.060933 7211.5700 59.0817
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 17 17.000000 850.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 17.000000 850.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 9.000000 450.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 19 77.750000 3887.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 11.000000 550.0000 50.0000
Subtotal (Total Children Is Unduplicated) 35 133.750000 6637.5000 49.6262
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Total 2777.310933 105610.6700 38.0262
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Number of Children (Unduplicated) With at Least One Service 1083
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Center 55
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4619 2777.310933 105610.6700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4619 2777.310933 105610.6700 0.0000