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:TPIN
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 1 0.500000 18.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 2.358872 87.7500 37.2000
Subtotal (Total Children Is Unduplicated) 2 2.858872 106.3500 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 15 27.000000 1984.9300 73.5159
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 18 34.500000 1914.7500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 221 409.500000 30080.6700 73.4571
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 47 85.500000 6108.6500 71.4462
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 55 98.500000 6989.5600 70.9600
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 300 567.000000 30849.0000 54.4074
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 36.000000 2650.0000 73.6111
Subtotal (Total Children Is Unduplicated) 343 1266.000000 81177.5600 64.1213
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Total 1268.858872 81283.9100 64.0606
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Number of Children (Unduplicated) With at Least One Service 344
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Center 57
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 0 0.000000 0.0000 0.0000
P 32 59.858872 3932.2500 7918.1900
D 116 216.500000 14355.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
533 992.500000 62995.9100 329.4000
Other 0 0.000000 0.0000 0.0000
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Total 681 1268.858872 81283.9100 8247.5900