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
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 87 174.000000 6472.8000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 49 138.250000 5142.9000 37.2000
Subtotal (Total Children Is Unduplicated) 93 312.250000 11615.7000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 20.000000 1500.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 22 41.500000 3112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 16.500000 1237.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 31 52.500000 2913.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.500000 1312.5000 75.0000
Subtotal (Total Children Is Unduplicated) 50 148.000000 10076.2500 68.0828
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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 697.750000 23258.9900 33.3343
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Number of Children (Unduplicated) With at Least One Service 107
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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 345 654.500000 20815.9400 20815.9400
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 0 0.000000 0.0000 0.0000
26 38.250000 2097.3000 0.0000
Other 3 5.000000 345.7500 0.0000
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Total 374 697.750000 23258.9900 20815.9400