CMS/EIP Fiscal Report Center: 55
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 543 766.500000 28475.3000 37.1498
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 28 28.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 615 3108.500000 115393.9500 37.1221
Subtotal (Total Children Is Unduplicated) 619 3903.500000 143869.2500 36.8565
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 19 72.000000 3600.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 6.000000 300.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 38 82.000000 6150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 17 34.000000 2550.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 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 13 26.000000 1443.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 451 906.999997 68025.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 62 128.000000 9600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 52 103.999999 7800.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 13 26.000000 1950.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 104 207.999999 15600.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 24 48.000000 3600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 258 516.000000 28638.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 42 84.000000 4662.0000 55.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 574 2259.999995 155269.4100 68.7033
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 10.000000 100.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 9.000000 647.6400 71.9600
Subtotal (Total Children Is Unduplicated) 2 19.000000 747.6400 39.3495
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Total 6182.499995 299886.3000 48.5057
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Number of Children (Unduplicated) With at Least One Service 619
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Center 55
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 327 574.953067 29186.2800 0.0000
P 1061 1830.086933 97551.0700 97348.0700
D 0 0.000000 0.0000 0.0000
S 1 1.333333 100.0000 0.0000
H 42 84.000000 6250.0000 0.0000
T 0 0.000000 0.0000 0.0000
3962 3692.126662 166798.9500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5393 6182.499995 299886.3000 97348.0700