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
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 686 592.250000 22031.7000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 522 2212.000000 82267.5000 37.1915
Subtotal (Total Children Is Unduplicated) 964 2804.250000 104299.2000 37.1933
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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 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 32 59.500000 4462.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 17.500000 1312.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 42 79.000000 4384.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
Subtotal (Total Children Is Unduplicated) 57 205.500000 13278.7500 64.6168
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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 3011.750000 117677.9500 39.0729
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Number of Children (Unduplicated) With at Least One Service 967
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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 0 0.000000 0.0000 0.0000
3112 3011.750000 117677.9500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3112 3011.750000 117677.9500 0.0000