CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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 4 1.250000 46.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 53 134.250000 4994.1000 37.2000
Subtotal (Total Children Is Unduplicated) 55 135.500000 5040.6000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 11.000000 610.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.500000 637.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 21.500000 1612.5000 75.0000
Subtotal (Total Children Is Unduplicated) 21 53.500000 3622.5000 67.7103
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
INTR-T1013-INTERPRETER 21 43.500000 1707.0000 39.2414
TRAV-TRAVS-Travel by mile 1 14.000000 6.2300 0.4450
Subtotal (Total Children Is Unduplicated) 22 58.500000 1763.2300 30.1407
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Total 247.500000 10426.3300 42.1266
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Number of Children (Unduplicated) With at Least One Service 69
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Center 01
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 30 62.500000 2085.2300 2085.2300
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 2.500000 102.7500 102.7500
208 182.500000 8238.3500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 240 247.500000 10426.3300 2187.9800