CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 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 37 16.500000 610.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 51 52.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 100 419.250000 15271.7500 36.4264
Subtotal (Total Children Is Unduplicated) 105 487.750000 15882.2500 32.5623
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 5.500000 412.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.000000 600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 13.500000 749.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 8.000000 600.0000 75.0000
Subtotal (Total Children Is Unduplicated) 26 45.000000 3111.7500 69.1500
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 5 5.000000 29.4600 5.8920
TRAV-TRAVS-Travel by mile 8 224.000000 99.7100 0.4451
Subtotal (Total Children Is Unduplicated) 11 230.000000 179.1700 0.7790
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Total 762.750000 19173.1700 25.1369
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Number of Children (Unduplicated) With at Least One Service 105
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Center 01
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 298 236.250000 8937.7500 0.0000
P 1 0.250000 9.2500 9.2500
D 0 0.000000 0.0000 0.0000
S 7 4.750000 289.7500 0.0000
H 6 9.000000 675.0000 0.0000
T 0 0.000000 0.0000 0.0000
342 261.000000 7733.0000 0.0000
Other 31 251.500000 1528.4200 0.0000
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Total 685 762.750000 19173.1700 9.2500