CMS/EIP Fiscal Report Center: 52
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 86 35.000000 1292.1500 36.9186
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 9 6.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 203 974.250000 36077.0000 37.0305
Subtotal (Total Children Is Unduplicated) 203 1015.250000 37369.1500 36.8078
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 168 355.000000 25001.4000 70.4265
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 70 143.500000 10462.5000 72.9094
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 45 97.000000 6945.0000 71.5979
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 166 333.000000 18259.5000 54.8333
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
Subtotal (Total Children Is Unduplicated) 185 993.500000 65124.1500 65.5502
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 21 11.000000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 3.000000 30.0000 10.0000
TRAV-TRAVS-Travel by mile 107 1801.000000 801.1900 0.4449
Subtotal (Total Children Is Unduplicated) 110 1815.000000 831.1900 0.4580
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Total 3823.750000 103324.4900 27.0218
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Number of Children (Unduplicated) With at Least One Service 203
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Center 52
Flag Claims Units Chgs Paid
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R 2 4.250000 233.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 113 153.250000 7747.3000 74.4000
P 506 723.750000 37484.2500 36138.5500
D 56 112.750000 6716.0500 110.0000
S 61 55.500000 2438.1500 204.9000
H 41 81.500000 5888.2500 0.0000
T 230 2010.500000 13620.3900 12409.9900
650 682.250000 29196.4000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1659 3823.750000 103324.4900 48937.8400