CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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 99 231.500000 8611.8000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 169 434.250000 16154.1000 37.2000
Subtotal (Total Children Is Unduplicated) 171 665.750000 24765.9000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 13.000000 975.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 14.000000 777.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 90 147.000000 10995.7500 74.8010
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 52 85.500000 6412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 34 59.500000 4462.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 127 200.000000 11100.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 27.000000 2025.0000 75.0000
Subtotal (Total Children Is Unduplicated) 164 555.000000 37422.7500 67.4284
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EI Services,Class #03
INTR-T1013-INTERPRETER 7 17.000000 850.0000 50.0000
Subtotal (Total Children Is Unduplicated) 7 17.000000 850.0000 50.0000
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Total 1237.750000 63038.6500 50.9300
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Number of Children (Unduplicated) With at Least One Service 172
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Center 09
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 133 194.250000 8969.5500 0.0000
P 313 423.250000 19086.9000 19083.6500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 150 169.500000 9475.0500 0.0000
T 0 0.000000 0.0000 0.0000
221 309.750000 15322.1500 0.0000
Other 74 141.000000 10185.0000 0.0000
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Total 891 1237.750000 63038.6500 19083.6500