CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 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 94 96.250000 3580.5000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 59 79.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 23 48.250000 1794.9000 37.2000
Subtotal (Total Children Is Unduplicated) 97 223.500000 5375.4000 24.0510
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 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 8 16.000000 1200.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 22.000000 1221.0000 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 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 21 61.500000 4144.5000 67.3902
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EI Services,Class #03
INTR-T1013-INTERPRETER 2 7.000000 350.0000 50.0000
TRAV-TRAVS-Travel by mile 53 3883.000000 1708.6300 0.4400
Subtotal (Total Children Is Unduplicated) 53 3890.000000 2058.6300 0.5292
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Total 4175.000000 11578.5300 2.7733
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Number of Children (Unduplicated) With at Least One Service 98
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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 68 2432.500000 3939.8400 3904.2400
9 179.000000 189.7600 0.0000
Other 427 1563.500000 7448.9300 0.0000
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Total 504 4175.000000 11578.5300 3904.2400