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
Agency Filter:EIP DEI DEIP
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 693 704.500000 26207.4000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 142 161.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 709 979.250000 36418.8000 37.1905
Subtotal (Total Children Is Unduplicated) 882 1845.250000 62626.2000 33.9391
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 24.500000 1837.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 97.500000 5411.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 33.500000 2512.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
Subtotal (Total Children Is Unduplicated) 76 199.000000 12672.7500 63.6822
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 7.500000 375.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 2 3.500000 175.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 10.000000 500.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 4 2.250000 112.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 3.500000 175.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 3 3.500000 175.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 18.250000 912.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 17 11.250000 562.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 8 46.500000 2325.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 40 131.250000 6562.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 15 48.000000 2400.0000 50.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 2 1.250000 46.2500 37.0000
TRAV-TRAVS-Travel by mile 93 7461.000000 3319.7400 0.4449
Subtotal (Total Children Is Unduplicated) 130 7748.250000 17653.4900 2.2784
-----------------------------------------------------------------------------------------------------------------------
Total 9792.500000 92952.4400 9.4922
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 904
-----------------------------------------------------------------------------------------------------------------------
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 1 0.500000 18.6000 0.0000
0 0.000000 0.0000 0.0000
Other 4083 9792.000000 92933.8400 0.0000
---------------------------------------------------------
Total 4084 9792.500000 92952.4400 0.0000