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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 798 682.750000 25398.3000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 169 200.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 159 297.500000 11067.0000 37.2000
Subtotal (Total Children Is Unduplicated) 830 1180.750000 36465.3000 30.8832
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 0.750000 37.5000 50.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 16.000000 1200.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 31.500000 1748.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
Subtotal (Total Children Is Unduplicated) 32 77.750000 5081.2500 65.3537
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.500000 75.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 6 8.250000 412.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 14 12.750000 637.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 6 3.250000 162.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 7.000000 350.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 0.750000 37.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 18.500000 925.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 21 11.500000 575.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 66.750000 3337.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 10.250000 512.5000 50.0000
TRAV-TRAVS-Travel by mile 109 9606.000000 4274.2200 0.4450
Subtotal (Total Children Is Unduplicated) 134 9748.000000 11336.7200 1.1630
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Total 11006.500000 52883.2700 4.8047
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Number of Children (Unduplicated) With at Least One Service 856
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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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 2995 11006.500000 52883.2700 0.0000
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Total 2995 11006.500000 52883.2700 0.0000