CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 4.250000 158.1000 37.2000
Subtotal (Total Children Is Unduplicated) 3 4.250000 158.1000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.500000 337.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 7.000000 525.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 9.500000 712.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 9.000000 675.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 58.000000 3219.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 28.500000 1581.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 57 95.500000 7162.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 46.000000 3450.0000 75.0000
Subtotal (Total Children Is Unduplicated) 118 266.500000 18242.2500 68.4512
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EI Services,Class #03
INTR-T1013-INTERPRETER 11 21.500000 1042.5000 48.4884
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 2.000000 24.0000 12.0000
TRAV-TRAVS-Travel by mile 9 219.000000 92.6000 0.4228
Subtotal (Total Children Is Unduplicated) 20 242.500000 1159.1000 4.7798
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Total 513.250000 19559.4500 38.1090
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Number of Children (Unduplicated) With at Least One Service 119
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Center 01
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 39 210.000000 2439.1900 2439.1900
D 5 31.500000 147.2600 0.0000
S 0 0.000000 0.0000 0.0000
H 137 193.000000 13373.2500 7917.7500
T 15 44.500000 1298.9000 1298.9000
27 34.250000 2300.8500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 223 513.250000 19559.4500 11655.8400