CMS/EIP Fiscal Report Center: 02
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
CASE-CASE-NON-TCM CASE MANAGEMENT 36 29.250000 1088.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 21.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 40 69.000000 2566.8000 37.2000
Subtotal (Total Children Is Unduplicated) 43 119.750000 3654.9000 30.5211
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 14.500000 1087.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.500000 562.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 15.500000 860.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 20 47.000000 3222.7500 68.5691
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EI Services,Class #03
INTR-T1013-INTERPRETER 5 11.500000 575.0000 50.0000
TRAV-TRAVS-Travel by mile 26 1529.000000 680.3500 0.4450
Subtotal (Total Children Is Unduplicated) 27 1540.500000 1255.3500 0.8149
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Total 1707.250000 8133.0000 4.7638
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Number of Children (Unduplicated) With at Least One Service 53
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Center 02
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 0 0.000000 0.0000 0.0000
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 53 1456.000000 2781.6900 2781.6900
0 0.000000 0.0000 0.0000
Other 203 251.250000 5351.3100 0.0000
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Total 256 1707.250000 8133.0000 2781.6900