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
Agency Filter:EIP DEI DEIP
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 116 228.500000 8500.2000 37.2000
Subtotal (Total Children Is Unduplicated) 116 228.500000 8500.2000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 3.500000 262.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 7.000000 388.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 31 40.000000 3000.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 51 70.000000 5250.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 78 103.000000 5716.5000 55.5000
Subtotal (Total Children Is Unduplicated) 86 227.000000 14880.0000 65.5507
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 6 3.000000 0.0000 0.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 4.000000 200.0000 50.0000
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 4.000000 287.8400 71.9600
Subtotal (Total Children Is Unduplicated) 8 11.000000 487.8400 44.3491
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Total 466.500000 23868.0400 51.1641
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Number of Children (Unduplicated) With at Least One Service 124
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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 3 2.250000 143.9200 143.9200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 258 340.500000 19102.2000 0.0000
T 9 6.500000 200.0000 200.0000
90 117.250000 4421.9200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 360 466.500000 23868.0400 343.9200