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
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
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-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 7.000000 388.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.000000 222.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.500000 487.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 7.500000 562.5000 75.0000
Subtotal (Total Children Is Unduplicated) 14 30.500000 2043.7500 67.0082
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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 277.250000 3360.9500 12.1225
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Number of Children (Unduplicated) With at Least One Service 35
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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 25 188.500000 1138.6900 1138.6900
D 4 30.000000 34.7600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 9 36.000000 749.1500 749.1500
19 22.750000 1438.3500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 57 277.250000 3360.9500 1887.8400