CMS/EIP Fiscal Report Center: 10
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
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 3291 10347.00000 384992.1000 37.2081
Subtotal (Total Children Is Unduplicated) 3291 10347.00000 384992.1000 37.2081
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 29.500000 2212.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.500000 562.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 17.500000 1237.5000 70.7143
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 370 729.000000 54787.5000 75.1543
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 121 243.500000 18262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 74 135.000000 10162.5000 75.2778
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 55 108.500000 8137.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 91 145.000000 11062.5000 76.2931
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 23.500000 1762.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 290 561.500000 31080.0000 55.3517
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 112 225.500000 12564.0000 55.7162
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 106 194.500000 14587.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 24.500000 1837.5000 75.0000
Subtotal (Total Children Is Unduplicated) 586 2469.500000 169762.5000 68.7437
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Total 12816.500000 554754.6000 43.2844
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Number of Children (Unduplicated) With at Least One Service 3293
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Center 10
Flag Claims Units Chgs Paid
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R 47 32.750000 1218.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 8349 7346.000000 314934.4500 0.0000
P 6 10.500000 748.5000 0.0000
D 15 11.000000 409.2000 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
5613 5124.500000 226478.8500 0.0000
Other 400 291.750000 10965.3000 0.0000
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Total 14430 12816.500000 554754.6000 0.0000