CMS/EIP Fiscal Report Center: 03
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 457 408.000000 15177.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 411 980.250000 36465.3000 37.2000
Subtotal (Total Children Is Unduplicated) 735 1388.250000 51642.9000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 0.750000 37.5000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 51 115.500000 6410.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 19.000000 1425.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
Subtotal (Total Children Is Unduplicated) 74 156.250000 9158.7500 58.6160
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 7.500000 375.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 2 5.000000 250.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 12 17.750000 887.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 9 9.750000 487.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 23 58.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 19.500000 975.0000 50.0000
Subtotal (Total Children Is Unduplicated) 35 117.500000 2975.0000 25.3191
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Total 1662.000000 63776.6500 38.3734
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Number of Children (Unduplicated) With at Least One Service 772
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Center 03
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
2607 1660.000000 63689.4500 0.0000
Other 2 2.000000 87.2000 0.0000
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Total 2609 1662.000000 63776.6500 0.0000