CMS/EIP Fiscal Report Center: 54
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 57 31.750000 1181.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 19 13.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 174 941.500000 35023.8000 37.2000
Subtotal (Total Children Is Unduplicated) 174 987.000000 36204.9000 36.6818
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 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 4 8.000000 600.0000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 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 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 29 48.000000 3600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 11.000000 825.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 50 92.500000 6937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 8.500000 637.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 34 59.500000 4462.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 15.500000 860.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 66 123.000000 6826.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 23.500000 1762.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 49.000000 3675.0000 75.0000
Subtotal (Total Children Is Unduplicated) 142 465.500000 32036.2500 68.8212
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EI Services,Class #03
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 0.750000 37.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 0.250000 12.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 0.250000 12.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 25 22.250000 0.0000 0.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 27 42.000000 420.0000 10.0000
TRAV-TRAVS-Travel by mile 12 125.000000 55.6000 0.4448
Subtotal (Total Children Is Unduplicated) 28 192.500000 638.1000 3.3148
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Total 1645.000000 68879.2500 41.8719
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Number of Children (Unduplicated) With at Least One Service 182
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Center 54
Flag Claims Units Chgs Paid
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R 1 1.000000 37.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 97 116.250000 5720.7000 0.0000
P 512 624.250000 27679.6000 27558.4000
D 4 6.750000 477.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 20 77.500000 1208.0200 1208.0200
653 802.250000 32858.8300 0.0000
Other 13 15.000000 747.0000 559.8000
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Total 1301 1645.000000 68879.2500 29326.2200