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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 258 158.000000 5877.6000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 59 56.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 64 64.000000 2380.8000 37.2000
Subtotal (Total Children Is Unduplicated) 291 278.500000 8258.4000 29.6531
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
Subtotal (Total Children Is Unduplicated) 8 19.000000 1210.5000 63.7105
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 20.0000 20.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 2 2.500000 125.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 5 2.500000 125.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 23.000000 1150.0000 50.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
TRAV-TRAVS-Travel by mile 38 1879.000000 836.0500 0.4449
Subtotal (Total Children Is Unduplicated) 51 1917.000000 2728.0100 1.4231
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Total 2214.500000 12196.9100 5.5077
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Number of Children (Unduplicated) With at Least One Service 321
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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 1 1.000000 20.0000 0.0000
0 0.000000 0.0000 0.0000
Other 700 2213.500000 12176.9100 0.0000
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Total 701 2214.500000 12196.9100 0.0000