CMS/EIP Fiscal Report Center: 57
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 329 346.750000 12883.6500 37.1554
TCM-T1017TL-TARGETED CASE MANAGEMENT 567 4162.000000 154651.5000 37.1580
Subtotal (Total Children Is Unduplicated) 567 4508.750000 167535.1500 37.1578
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 12 21.500000 1612.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 13.500000 1012.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 21 39.000000 2164.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 322 532.500000 39421.2700 74.0306
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 96 159.500000 11925.0000 74.7649
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 125 191.500000 14130.2300 73.7871
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 460 790.500000 43622.7500 55.1837
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 86.500000 6266.5900 72.4461
Subtotal (Total Children Is Unduplicated) 548 1841.500000 120680.3400 65.5337
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 3.000000 30.0000 10.0000
Subtotal (Total Children Is Unduplicated) 3 3.000000 30.0000 10.0000
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Total 6353.250000 288245.4900 45.3698
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Number of Children (Unduplicated) With at Least One Service 567
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Center 57
Flag Claims Units Chgs Paid
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R 6 11.750000 511.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 548 992.500000 46308.6000 0.0000
P 1008 1956.500000 88431.7500 89103.1700
D 57 95.500000 6265.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 32 53.250000 3553.9500 2363.1500
2148 3240.750000 143144.1900 525.0000
Other 3 3.000000 30.0000 30.0000
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Total 3802 6353.250000 288245.4900 92021.3200