CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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 72 95.500000 3534.0000 37.0052
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 43 44.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 70 220.000000 8184.0000 37.2000
Subtotal (Total Children Is Unduplicated) 76 359.750000 11718.0000 32.5726
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 28.000000 2100.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 45.500000 2525.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 17.500000 1312.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.500000 1012.5000 75.0000
Subtotal (Total Children Is Unduplicated) 43 132.000000 8837.2500 66.9489
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-T1013-INTERPRETER 5 25.500000 1275.0000 50.0000
TRAV-TRAVS-Travel by mile 35 1814.000000 807.1400 0.4450
Subtotal (Total Children Is Unduplicated) 36 1839.500000 2082.1400 1.1319
-----------------------------------------------------------------------------------------------------------------------
Total 2331.250000 22637.3900 9.7104
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 76
-----------------------------------------------------------------------------------------------------------------------
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
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 63 952.500000 4588.2400 4588.2400
4 46.000000 20.4600 0.0000
Other 632 1332.750000 18028.6900 0.0000
---------------------------------------------------------
Total 699 2331.250000 22637.3900 4588.2400