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
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 74 72.000000 2678.4000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 91 515.000000 19156.2000 37.1965
Subtotal (Total Children Is Unduplicated) 124 587.000000 21834.6000 37.1969
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 24 38.000000 2850.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 5 8.500000 637.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 29 51.000000 2830.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 31 102.500000 6693.0000 65.2976
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 8.000000 80.0000 10.0000
Subtotal (Total Children Is Unduplicated) 1 8.000000 80.0000 10.0000
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Total 697.500000 28607.6000 41.0145
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Number of Children (Unduplicated) With at Least One Service 125
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Center 57
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 2 8.000000 80.0000 80.0000
437 689.500000 28527.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 439 697.500000 28607.6000 80.0000