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
Agency Filter:EXT
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
Subtotal (Total Children Is Unduplicated) 4 8.000000 444.0000 55.5000
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 6.750000 337.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 5 7.250000 362.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 3.000000 150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 32 183.000000 9150.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 34.000000 1700.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 288 1109.000000 11090.0000 10.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 19 12.000000 444.0000 37.0000
TRAV-TRAVS-Travel by mile 283 18841.00000 8381.9400 0.4449
Subtotal (Total Children Is Unduplicated) 302 20203.00000 31940.9400 1.5810
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Total 20211.000000 32384.9400 1.6023
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Number of Children (Unduplicated) With at Least One Service 306
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1307 11427.500000 17254.0800 17254.0800
1131 8783.500000 15130.8600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2438 20211.000000 32384.9400 17254.0800