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
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 692 668.000000 24849.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1490 6279.500000 233597.4000 37.2000
Subtotal (Total Children Is Unduplicated) 1531 6947.500000 258447.0000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 9 19.500000 975.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 22 41.000000 3075.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.000000 225.0000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 29 54.000000 2997.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 228 416.500000 30935.9400 74.2760
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 67 121.000000 9030.1500 74.6293
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 46 78.000000 5850.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 313 583.000000 32206.5000 55.2427
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 30 53.000000 3975.0000 75.0000
Subtotal (Total Children Is Unduplicated) 383 1384.000000 90394.5900 65.3140
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Total 8331.500000 348841.5900 41.8702
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Number of Children (Unduplicated) With at Least One Service 1531
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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 2288 3279.250000 137300.4000 251.1000
P 1047 1531.500000 67767.4500 67580.9400
D 2 4.000000 261.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 13.500000 944.2500 488.8500
3198 3282.750000 134365.8900 150.0000
Other 193 220.500000 8202.6000 0.0000
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Total 6735 8331.500000 348841.5900 68470.8900