CMS/EIP Fiscal Report Center: 52
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 18 7.750000 288.3000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 64 250.500000 9327.9000 37.2371
Subtotal (Total Children Is Unduplicated) 64 260.000000 9616.2000 36.9854
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 34 69.500000 5047.7000 72.6288
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 18.000000 1350.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 28.000000 2100.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 18.500000 1387.5000 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 47 92.000000 5106.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 53 236.000000 15702.2000 66.5347
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2 1.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 150.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 3.000000 36.0000 12.0000
TRAV-TRAVS-Travel by mile 18 215.000000 95.6700 0.4450
Subtotal (Total Children Is Unduplicated) 20 222.000000 281.6700 1.2688
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Total 718.000000 25600.0700 35.6547
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Number of Children (Unduplicated) With at Least One Service 64
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Center 52
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 32 44.000000 2199.6000 65.1000
P 78 117.250000 6155.3600 6077.3500
D 3 6.000000 450.0000 0.0000
S 33 31.500000 1323.0000 30.0000
H 8 15.500000 1162.5000 0.0000
T 48 268.000000 3556.7100 3329.5100
201 235.750000 10752.9000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 403 718.000000 25600.0700 9501.9600