CMS/EIP Fiscal Report Center: 03
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
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 36 61.000000 2269.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 97 274.250000 10202.1000 37.2000
Subtotal (Total Children Is Unduplicated) 107 335.250000 12471.3000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 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 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 32.000000 2400.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 25.500000 1912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 16.000000 1190.0000 74.3750
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 84.000000 4662.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 11.500000 862.5000 75.0000
Subtotal (Total Children Is Unduplicated) 76 180.000000 11783.7500 65.4653
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Total 515.250000 24255.0500 47.0743
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Number of Children (Unduplicated) With at Least One Service 114
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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 7 11.500000 464.4000 0.0000
P 30 45.250000 2649.1500 2649.1500
D 1 0.500000 18.6000 0.0000
S 0 0.000000 0.0000 0.0000
H 9 16.500000 1071.7500 1071.7500
T 0 0.000000 0.0000 0.0000
317 433.750000 19762.8500 0.0000
Other 4 7.750000 288.3000 0.0000
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Total 368 515.250000 24255.0500 3720.9000