CMS/EIP Fiscal Report Center: 57
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 89 81.250000 3022.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 171 1076.500000 40045.8000 37.2000
Subtotal (Total Children Is Unduplicated) 171 1157.750000 43068.3000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 78 131.500000 9837.2500 74.8080
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 29 47.500000 3562.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 36 53.000000 3975.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 126 213.500000 11849.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 27.500000 2062.5000 75.0000
Subtotal (Total Children Is Unduplicated) 146 485.000000 32069.5000 66.1227
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 7.000000 350.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 7.000000 70.0000 10.0000
Subtotal (Total Children Is Unduplicated) 1 14.000000 420.0000 30.0000
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Total 1656.750000 75557.8000 45.6060
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Number of Children (Unduplicated) With at Least One Service 172
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Center 57
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 280 522.000000 22966.0500 83.2500
P 139 265.750000 13142.7000 12809.2700
D 1 1.500000 112.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4 11.000000 331.0000 182.2000
569 855.000000 38949.7500 350.0000
Other 1 1.500000 55.8000 0.0000
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Total 994 1656.750000 75557.8000 13424.7200