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
Payclass Filters:MED
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 2253 7529.750000 279957.9000 37.1802
Subtotal (Total Children Is Unduplicated) 2253 7529.750000 279957.9000 37.1802
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 11.000000 825.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 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 3 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 90 165.500000 12337.5000 74.5468
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 102 200.000000 15000.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 34 62.500000 4687.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 53 99.500000 7462.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 48 82.000000 6150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 25 43.500000 3262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 122 224.500000 12432.0000 55.3764
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 133 255.000000 14152.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 61 96.000000 7162.5000 74.6094
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 29.000000 2175.0000 75.0000
Subtotal (Total Children Is Unduplicated) 338 1314.000000 88737.7500 67.5325
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Total 8843.750000 368695.6500 41.6900
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Number of Children (Unduplicated) With at Least One Service 2255
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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
309 156.500000 5821.8000 0.0000
Other 390 293.500000 10918.2000 0.0000
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Total 10527 8843.750000 368695.6500 0.0000