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
Payclass Filters:GR
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 288 2074.000000 77056.9500 37.1538
Subtotal (Total Children Is Unduplicated) 446 2420.750000 89940.6000 37.1540
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.500000 527.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 60 99.000000 7425.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 12 22.500000 1650.0000 73.3333
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 15 22.000000 1650.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 80 138.500000 7686.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
Subtotal (Total Children Is Unduplicated) 94 305.500000 19989.0000 65.4304
-----------------------------------------------------------------------------------------------------------------------
Total 2726.250000 109929.6000 40.3226
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 446
-----------------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 2 3.500000 262.5000 262.5000
1839 2722.750000 109667.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1841 2726.250000 109929.6000 262.5000