CMS/EIP Fiscal Report Center: 04
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 771 786.000000 29239.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 422 1924.500000 71591.4000 37.2000
Subtotal (Total Children Is Unduplicated) 971 2710.500000 100830.6000 37.2000
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 5 5.000000 250.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 3 6.500000 325.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 12 9.500000 475.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 61 84.000000 6300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 81 122.000000 6771.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 40 46.500000 3487.5000 75.0000
Subtotal (Total Children Is Unduplicated) 108 291.500000 18880.5000 64.7702
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Total 3002.000000 119711.1000 39.8771
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Number of Children (Unduplicated) With at Least One Service 981
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Center 04
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 1 1.000000 37.2000 93.0000
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 0 0.000000 0.0000 0.0000
2623 3001.000000 119673.9000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2624 3002.000000 119711.1000 93.0000