CMS/EIP Fiscal Report Center: 57
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 74 72.000000 2678.4000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 167 1058.750000 39377.7000 37.1926
Subtotal (Total Children Is Unduplicated) 167 1130.750000 42056.1000 37.1931
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 94 157.500000 11812.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 26 42.000000 3150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 27 42.000000 3150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 133 232.500000 12903.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 15.500000 1162.5000 75.0000
Subtotal (Total Children Is Unduplicated) 151 512.000000 33642.0000 65.7070
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 8.000000 400.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 8.000000 80.0000 10.0000
Subtotal (Total Children Is Unduplicated) 1 16.000000 480.0000 30.0000
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Total 1658.750000 76178.1000 45.9250
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Number of Children (Unduplicated) With at Least One Service 168
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Center 57
Flag Claims Units Chgs Paid
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R 14 36.750000 1367.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 276 566.750000 25866.5500 0.0000
P 91 170.000000 8570.7500 8570.1500
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 9 25.000000 769.1000 676.6600
535 860.250000 39604.6000 400.0000
Other 0 0.000000 0.0000 0.0000
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Total 925 1658.750000 76178.1000 9646.8100