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
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1936 15915.11828 591324.4500 37.1549
Subtotal (Total Children Is Unduplicated) 1936 15915.11828 591324.4500 37.1549
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 31 53.000000 3975.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 13 23.000000 1725.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 11.500000 862.5000 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 3 5.500000 412.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 47 86.500000 4800.7500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 577 1044.500000 78269.2500 74.9347
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 179 319.500000 23917.5000 74.8592
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 146 248.500000 18637.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 795 1473.000000 81751.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 91 162.500000 12187.5000 75.0000
Subtotal (Total Children Is Unduplicated) 949 3433.000000 226951.5000 66.1088
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Total 19348.118280 818275.9500 42.2923
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Number of Children (Unduplicated) With at Least One Service 1937
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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 4237 5957.250000 257162.3000 139.5000
P 8905 12752.618280 534773.3500 534808.2160
D 5 8.750000 324.3500 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
0 0.000000 0.0000 0.0000
Other 408 374.250000 13907.3500 0.0000
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Total 13719 19348.118280 818275.9500 542714.4160