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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 686 592.250000 22031.7000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1440 5785.750000 215186.2000 37.1924
Subtotal (Total Children Is Unduplicated) 1501 6378.000000 237217.9000 37.1931
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 8 21.000000 1050.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 19.000000 1425.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 16 30.000000 1665.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 226 413.000000 30945.7500 74.9292
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 52 97.500000 7312.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 51 91.000000 6825.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 295 553.000000 30691.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 30 52.500000 3937.5000 75.0000
Subtotal (Total Children Is Unduplicated) 351 1286.000000 84527.2500 65.7288
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EI Services,Class #03
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1 2.000000 100.0000 50.0000
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Total 7666.000000 321845.1500 41.9835
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Number of Children (Unduplicated) With at Least One Service 1504
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Center 57
Flag Claims Units Chgs Paid
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R 134 177.000000 6584.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 1781 2491.750000 105369.9500 0.0000
P 816 1233.250000 54598.4500 54784.7060
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 81 121.250000 4510.5000 4486.3000
3296 3357.750000 140180.5000 0.0000
Other 259 285.000000 10601.3500 0.0000
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Total 6367 7666.000000 321845.1500 59271.0060