CMS/EIP Fiscal Report Center: 06
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 45 22.500000 837.0000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 80 357.750000 13308.3000 37.2000
Subtotal (Total Children Is Unduplicated) 81 380.250000 14145.3000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 26.000000 1950.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 48 77.500000 5812.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 11.500000 862.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 12 18.500000 1387.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 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 14 21.500000 1193.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 44 73.500000 4079.2500 55.5000
Subtotal (Total Children Is Unduplicated) 72 232.000000 15547.5000 67.0151
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EI Services,Class #03
INTR-T1013-INTERPRETER 3 6.000000 344.0000 57.3333
Subtotal (Total Children Is Unduplicated) 3 6.000000 344.0000 57.3333
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Total 618.250000 30036.8000 48.5836
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Number of Children (Unduplicated) With at Least One Service 83
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Center 06
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 5 10.000000 566.0000 566.0000
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 2.250000 83.7000 0.0000
520 597.750000 29080.2000 0.0000
Other 7 8.250000 306.9000 0.0000
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Total 533 618.250000 30036.8000 566.0000