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
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 72 95.500000 3534.0000 37.0052
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 43 44.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 28 82.500000 3069.0000 37.2000
Subtotal (Total Children Is Unduplicated) 76 222.250000 6603.0000 29.7098
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Screening, Eval, and Assessment,Class #02
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 6 9.500000 712.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 18.500000 1026.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
Subtotal (Total Children Is Unduplicated) 18 50.000000 3243.0000 64.8600
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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
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Total 2111.750000 11928.1400 5.6485
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Number of Children (Unduplicated) With at Least One Service 76
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Center 02
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 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 52 933.500000 3163.2400 3163.2400
4 46.000000 20.4600 0.0000
Other 415 1132.250000 8744.4400 0.0000
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Total 471 2111.750000 11928.1400 3163.2400