CMS/EIP Fiscal Report Center: 02
Services beginning 07/01/2022 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 257 434.000000 16105.1500 37.1086
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 174 231.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 263 910.750000 33827.4500 37.1424
Subtotal (Total Children Is Unduplicated) 265 1575.750000 49932.6000 31.6881
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.500000 637.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC 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-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 57 99.000000 7425.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 29 52.500000 3937.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 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 101 183.000000 10156.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 26 45.500000 2525.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 82.500000 6187.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 43.500000 3262.5000 75.0000
Subtotal (Total Children Is Unduplicated) 175 535.000000 35562.0000 66.4710
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EI Services,Class #03
INTR-T1013-INTERPRETER 11 42.750000 2137.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 30.000000 300.0000 10.0000
TRAV-TRAVS-Travel by mile 158 11492.00000 5094.3200 0.4433
Subtotal (Total Children Is Unduplicated) 160 11564.75000 7531.8200 0.6513
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Total 13675.500000 93026.4200 6.8024
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Number of Children (Unduplicated) With at Least One Service 266
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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 288 8088.750000 16959.1200 16912.8400
10 181.000000 339.7600 0.0000
Other 2941 5405.750000 75727.5400 0.0000
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Total 3239 13675.500000 93026.4200 16912.8400