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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 1689 2679.750000 99568.3500 37.1558
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 511 659.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 402 1116.500000 41476.1000 37.1483
Subtotal (Total Children Is Unduplicated) 1759 4455.250000 141044.4500 31.6580
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 0.750000 37.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 31.000000 2325.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 18.500000 1387.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 64 120.000000 6604.5000 55.0375
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 18 33.000000 1831.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 45.000000 3375.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 37.000000 2775.0000 75.0000
Subtotal (Total Children Is Unduplicated) 110 296.750000 19091.2500 64.3345
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 10 12.000000 600.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 21 32.000000 1600.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 36 50.000000 2500.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 15 11.500000 575.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 0.750000 18.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 10 10.500000 525.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 4 4.250000 212.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 54 60.000000 3000.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 53 38.750000 1937.5000 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 29 248.750000 12437.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 40.000000 2000.0000 50.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 9 6.000000 222.0000 37.0000
TRAV-TRAVS-Travel by mile 269 27526.00000 12247.2800 0.4449
Subtotal (Total Children Is Unduplicated) 328 28089.50000 40263.0300 1.4334
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Total 32841.500000 200398.7300 6.1020
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Number of Children (Unduplicated) With at Least One Service 1771
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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 1 0.500000 18.6000 0.0000
0 0.000000 0.0000 0.0000
Other 10828 32841.000000 200380.1300 0.0000
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Total 10829 32841.500000 200398.7300 0.0000