CMS/EIP Fiscal Report Center: 53
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 90 176.750000 6556.5000 37.0948
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 6.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 113 391.500000 14545.2000 37.1525
Subtotal (Total Children Is Unduplicated) 113 575.000000 21101.7000 36.6986
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Screening, Eval, and Assessment,Class #02
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 1.500000 75.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 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 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.500000 187.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 27 42.500000 3187.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.000000 675.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 24 39.500000 2962.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 20 30.500000 2287.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 17.500000 971.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 55 90.000000 4995.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 18.500000 1387.5000 75.0000
Subtotal (Total Children Is Unduplicated) 94 277.500000 18581.2500 66.9595
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 11 12.500000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12 16.000000 160.0000 10.0000
TRAV-TRAVS-Travel by mile 5 153.000000 68.0700 0.4449
Subtotal (Total Children Is Unduplicated) 12 181.500000 228.0700 1.2566
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Total 1034.000000 39911.0200 38.5987
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Number of Children (Unduplicated) With at Least One Service 114
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Center 53
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 82 76.500000 3742.9500 0.0000
P 253 272.750000 12929.7000 12927.3000
D 6 9.500000 595.5000 0.0000
S 29 22.750000 1073.1000 0.0000
H 0 0.000000 0.0000 0.0000
T 6 138.000000 90.0700 90.0700
598 488.250000 20147.1000 0.0000
Other 27 26.250000 1332.6000 0.0000
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Total 1001 1034.000000 39911.0200 13017.3700