CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Payclass Filters:GR
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 119 256.000000 9523.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 71 209.000000 7774.8000 37.2000
Subtotal (Total Children Is Unduplicated) 127 465.000000 17298.0000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 20 37.500000 2812.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 11 20.500000 1537.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 19 35.000000 2625.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 21 38.000000 2109.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.500000 1012.5000 75.0000
Subtotal (Total Children Is Unduplicated) 47 148.500000 10357.5000 69.7475
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EI Services,Class #03
INTR-T1013-INTERPRETER 12 44.000000 2200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 12 44.000000 2200.0000 50.0000
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Total 657.500000 29855.5000 45.4076
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Number of Children (Unduplicated) With at Least One Service 129
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Center 09
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 321 420.500000 19381.4500 19381.4500
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 168 199.750000 8218.9500 8218.9500
10 14.250000 530.1000 0.0000
Other 12 23.000000 1725.0000 0.0000
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Total 511 657.500000 29855.5000 27600.4000