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
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 257 434.000000 16105.1500 37.1086
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 174 231.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 93 299.500000 11126.6500 37.1508
Subtotal (Total Children Is Unduplicated) 262 964.500000 27231.8000 28.2341
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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-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-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 27 47.000000 3525.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 15 28.000000 2100.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 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 47 85.500000 4745.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 13 23.500000 1304.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 38.000000 2850.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.000000 1275.0000 75.0000
Subtotal (Total Children Is Unduplicated) 82 258.000000 17117.2500 66.3459
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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 12787.250000 51880.8700 4.0572
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Number of Children (Unduplicated) With at Least One Service 263
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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 268 8053.250000 14296.6200 14250.3400
9 179.000000 189.7600 0.0000
Other 1960 4555.000000 37394.4900 0.0000
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Total 2237 12787.250000 51880.8700 14250.3400