CMS/EIP Fiscal Report Center: 03
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 151 196.000000 7288.2000 37.1847
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 363 1517.500000 56392.1500 37.1612
Subtotal (Total Children Is Unduplicated) 373 1715.250000 63680.3500 37.1260
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 69 121.500000 9038.5000 74.3909
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 59 110.500000 8172.1100 73.9557
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 51 87.500000 6452.5000 73.7429
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 189 336.500000 18675.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.000000 222.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 65.500000 4912.5000 75.0000
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 291 766.000000 50137.8600 65.4541
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 2.000000 100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 5.000000 250.0000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 11.000000 110.0000 10.0000
TRAV-TRAVS-Travel by mile 2 134.000000 59.6100 0.4449
Subtotal (Total Children Is Unduplicated) 4 156.000000 719.6100 4.6129
-----------------------------------------------------------------------------------------------------------------------
Total 2637.250000 114537.8200 43.4308
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 377
-----------------------------------------------------------------------------------------------------------------------
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 6.000000 223.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 332 438.500000 17625.5000 0.0000
P 328 600.750000 28431.1900 28321.1900
D 5 7.250000 297.1500 0.0000
S 0 0.000000 0.0000 0.0000
H 13 34.500000 1387.5300 1387.5300
T 0 0.000000 0.0000 0.0000
1307 1516.500000 65281.3500 0.0000
Other 25 33.750000 1291.9000 0.0000
---------------------------------------------------------
Total 2014 2637.250000 114537.8200 29708.7200