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
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 36 29.250000 1088.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 21.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 11 21.250000 790.5000 37.2000
Subtotal (Total Children Is Unduplicated) 39 72.000000 1878.6000 26.0917
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 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) 9 22.000000 1581.7500 71.8977
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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 1634.500000 4715.7000 2.8851
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Number of Children (Unduplicated) With at Least One Service 49
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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 51 1453.500000 2594.1900 2594.1900
0 0.000000 0.0000 0.0000
Other 125 181.000000 2121.5100 0.0000
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Total 176 1634.500000 4715.7000 2594.1900