CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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
TCM-T1017TL-TARGETED CASE MANAGEMENT 3427 11414.25000 424461.3000 37.1870
Subtotal (Total Children Is Unduplicated) 3427 11414.25000 424461.3000 37.1870
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 3.500000 175.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 18.500000 1387.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 19.500000 1462.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 13.000000 975.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.500000 187.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 11 21.000000 1165.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 154 297.500000 22237.5000 74.7479
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 202 398.000000 29850.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 55 105.500000 7912.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 97 185.500000 13912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 72 122.500000 9187.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 42 74.000000 5550.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 188 354.500000 19619.2500 55.3434
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 258 499.500000 27722.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 101 177.500000 13275.0000 74.7887
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 48.500000 3637.5000 75.0000
Subtotal (Total Children Is Unduplicated) 590 2378.500000 160757.5000 67.5878
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Total 13792.750000 585218.8000 42.4295
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Number of Children (Unduplicated) With at Least One Service 3430
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Center 10
Flag Claims Units Chgs Paid
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R 7 5.000000 186.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9658 8202.250000 340864.0500 0.0000
P 0 0.000000 0.0000 0.0000
D 163 186.500000 10905.6000 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
5965 5101.500000 222196.1500 0.0000
Other 397 297.500000 11067.0000 0.0000
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Total 16190 13792.750000 585218.8000 0.0000