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
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 45 22.500000 837.0000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 44 190.000000 7068.0000 37.2000
Subtotal (Total Children Is Unduplicated) 65 212.500000 7905.0000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.500000 249.7500 55.5000
Subtotal (Total Children Is Unduplicated) 4 11.000000 717.7500 65.2500
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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 229.500000 8966.7500 39.0708
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Number of Children (Unduplicated) With at Least One Service 67
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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 3 6.000000 344.0000 344.0000
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
231 213.000000 8232.1500 0.0000
Other 7 8.250000 306.9000 0.0000
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Total 242 229.500000 8966.7500 344.0000