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
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 644 1407.000000 52340.4000 37.2000
Subtotal (Total Children Is Unduplicated) 644 1407.000000 52340.4000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 7.500000 416.2500 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 55 105.500000 5855.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.500000 487.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 67 127.000000 7203.2500 56.7185
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 30.000000 1500.0000 50.0000
Subtotal (Total Children Is Unduplicated) 6 30.000000 1500.0000 50.0000
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Total 1564.000000 61043.6500 39.0305
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Number of Children (Unduplicated) With at Least One Service 647
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Center 03
Flag Claims Units Chgs Paid
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R 4 3.000000 111.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 210 122.250000 4692.8000 0.0000
P 144 111.000000 4618.2500 4619.0900
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
1735 1288.250000 50050.9500 0.0000
Other 39 39.500000 1570.0500 0.0000
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Total 2132 1564.000000 61043.6500 4619.0900