CMS/EIP Fiscal Report Center: 52
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 28 11.250000 409.2000 36.3733
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 2.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 75 293.250000 10899.6000 37.1683
Subtotal (Total Children Is Unduplicated) 75 306.750000 11308.8000 36.8665
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 44 92.000000 6560.0000 71.3043
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 48.000000 3450.0000 71.8750
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 18.000000 1190.0000 66.1111
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 97.500000 5411.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 63 279.500000 18255.2500 65.3140
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 8 3.750000 0.0000 0.0000
TRAV-TRAVS-Travel by mile 27 378.000000 168.1500 0.4448
Subtotal (Total Children Is Unduplicated) 29 381.750000 168.1500 0.4405
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Total 968.000000 29732.2000 30.7151
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Number of Children (Unduplicated) With at Least One Service 76
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Center 52
Flag Claims Units Chgs Paid
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R 2 1.000000 37.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 49 73.250000 3890.7000 0.0000
P 151 204.000000 10055.2000 9767.8300
D 13 26.000000 1599.0000 0.0000
S 21 17.000000 820.2000 82.2000
H 18 35.000000 2283.7500 0.0000
T 54 425.500000 3104.6500 2904.6500
176 186.250000 7941.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 484 968.000000 29732.2000 12754.6800