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
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1905 2668.250000 99161.7500 37.1636
TCM-T1017TL-TARGETED CASE MANAGEMENT 2900 25048.22715 930623.0000 37.1532
Subtotal (Total Children Is Unduplicated) 2934 27716.47715 1029784.7500 37.1542
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 33 74.000000 3700.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 66 118.000000 8809.9300 74.6604
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 21 38.500000 2887.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 9 14.500000 1087.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 6 11.500000 862.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 89 167.500000 9296.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 918 1673.500000 124762.4200 74.5518
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 249 449.500000 33363.6500 74.2239
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 221 382.000000 28252.0600 73.9583
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1255 2340.000000 129200.5000 55.2139
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 121 220.000000 16450.0000 74.7727
Subtotal (Total Children Is Unduplicated) 1504 5494.500000 359084.8100 65.3535
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EI Services,Class #03
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 8.000000 400.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 2 9.000000 450.0000 50.0000
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Total 33219.977152 1389319.5600 41.8218
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Number of Children (Unduplicated) With at Least One Service 2935
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Center 57
Flag Claims Units Chgs Paid
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R 19 32.750000 1442.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 4238 5959.250000 257312.3000 139.5000
P 8937 12812.477152 538705.6000 542726.4060
D 136 245.250000 15534.7500 92.5000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 145 222.500000 10665.9000 7674.2000
13195 13572.000000 551695.1600 329.4000
Other 410 375.750000 13963.1500 0.0000
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Total 27080 33219.977152 1389319.5600 550962.0060