CMS/EIP Fiscal Report Center: 09
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 87 174.000000 6472.8000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 126 314.500000 11699.4000 37.2000
Subtotal (Total Children Is Unduplicated) 130 488.500000 18172.2000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 2.500000 138.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 15.000000 1125.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 60 96.000000 7200.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 74 125.000000 9375.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 27 47.500000 3562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 15.000000 832.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 114 180.500000 10047.0000 55.6620
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 34.500000 2587.5000 75.0000
Subtotal (Total Children Is Unduplicated) 161 522.500000 35326.5000 67.6105
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EI Services,Class #03
INTR-T1013-INTERPRETER 10 29.500000 1475.0000 50.0000
TRAV-TRAVS-Travel by mile 4 208.000000 92.0400 0.4425
Subtotal (Total Children Is Unduplicated) 13 237.500000 1567.0400 6.5981
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Total 1248.500000 55065.7400 44.1055
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Number of Children (Unduplicated) With at Least One Service 163
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Center 09
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 353 668.000000 21789.4400 21789.4400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 264 382.750000 20281.2000 11017.2000
T 0 0.000000 0.0000 0.0000
78 125.750000 8141.1000 0.0000
Other 41 72.000000 4854.0000 0.0000
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Total 736 1248.500000 55065.7400 32806.6400